Care Coordinator, Temporary , Intake: Labelle Pembroke

Care Coordinator, Temporary Full Time, Intake:
Labelle, Cornwall, Pembroke (1.0)

Apply for the Care Coordinator role at Ontario Health atHome
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As a bilingual Care Coordinator, you will assess and determine patient care needs and eligibility, provide access and referrals to community services, and engage with patients, caregivers and other health care practitioners.

Whether you work in our office, in the community, or a health care facility – you will play a lead role in providing connected, accessible, patient‑centered care – and be supported by our collaborative team that includes over 8,000 regulated health care and other professionals.

As a valued team member, your mission will be to help our patients be healthier at home, while you benefit from our supports for professional growth, personal wellness and work‑life balance.

Under the general direction of the Manager, Patient Services, the Care Coordinator is responsible for managing a caseload of diverse patients who are living and/or dealing with a variety of health concerns. The Care Coordinator, through phone conversations, assesses the patient’s care needs and develops, implements, and updates (as required) a care plan that is informed by the patient’s health and psychosocial needs;

and, where possible, accommodates patient and caregiver wishes. He/she also determines eligibility for and arranges for Ontario Health atHome Champlain‑approved health care services and refers patients and caregivers to other community resources and programs.

• Completes comprehensive patient assessments using a validated assessment tool, including patient’s clinical, physical and psychosocial needs, and caregiver needs.
• Assesses the patient’s and caregiver’s understanding of, and learning needs related to diagnosis, treatment, available resources, illness adjustment, and coping mechanisms.
• Assists patient and caregiver in setting appropriate goals (individual, joint, short or long term).
• Collaborates with patient, caregiver and the care team to develop an individualized care and service plan reflective of the patient’s identified priorities and desired outcomes; identifies strategies and resources to be used in attaining clinical outcomes.
• Coordinates the delivery of home and community care services to patients and their caregivers.
• Coordinates vendor and resource utilization involving medical equipment, supplies and services.
• Facilitates understanding and cooperation among members of the patient’s multidisciplinary healthcare team; communicates with members of the patient’s health care team to maximize patient outcomes.
• Initiates and authorizes the implementation of the care plan through contracted providers.
• Provides regular reports to physicians, service providers, patients, caregivers and other authorized parties as required.
• Case documentation in accordance with Ontario Health atHome Champlain policies.

Team/Department: Intake

Hours of work: A rotating shift schedule comprised of eight‑hour shifts with various start times between the hours of 8am and 8pm, seven days a week for a total of 70 hours biweekly.

FTE: 1.0
Length of temporary assignment: June 26, 2026
Starting salary: $44,480 to $47,517
Affiliation: OPSEU
Reporting to: Manager, Patient Services
Office location: Cornwall, Labelle, Pembroke

• Registered Nurse (BScN or diploma) and registered with the College of Nurses of Ontario; or
• Degree or diploma in Physiotherapy and registered with the College of Physiotherapy of Ontario; or
• Degree or diploma in Occupational Therapy and registered with the College of Occupational Therapy of Ontario; or
• Degree in Social Work and registered with the Ontario College of Social Workers and Social Service Workers; or
• Degree in Speech Therapy and registered with the College of Audiologists and Speech‑Language Pathologists of Ontario; or
• Degree in Foods and Nutrition or equivalent and registered with College of Dietitians of Ontario.
• Related professional experience (community‑based experience preferred) which is normally attained over a period of two years.

• Works with diverse patient groups with varying…