Care Coordinator - Children's Health Services

Job Description

Are you an experienced registered nurse (BScN), physiotherapist, occupational therapist, social worker, or speech language pathologist seeking a rewarding career that cares for others, in a professional practice that cares for you? You’re looking in the right place.

As a Care Coordinator - Children's Health Services you will collaborate with the patient/family who will be responsible for assessing, planning, coordinating, implementing and reviewing patients’ needs and services provided by the Ontario Health atHome and at school, following Ministry of Health legislation and Ontario Health atHome policies and procedures. Responsible for providing information to patients and family as well as referring them to alternate community resources.

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-centred care – and be supported by our collaborative team that includes over 9,000 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.

What will you do?

Patient Care Delivery

• Responds to inquiries from patient/family, service provider or others
• Obtains consent for the gathering and sharing of patient information
• Determines eligibility for Ontario Health atHome funded, in-home services or need to navigate to alternate community services
• Develops service plan in accordance with the patient’s care needs, patient capability, identified risk factors including potential abusive situations and urgency for services
• Collaborates with patient/family and service providers to establish patient goals and quality outcomes (patient-centered care) utilizing best practices
• Commitment to continuous quality improvement and excellence in all activities and outcomes
• Provides the patient/family with information about legislation, Ontario Health atHome services, patient rights and responsibilities and appeals processes
• Provides information and referrals to access alternative community resources and supports
• Oversee the implementation of service plans
• Reassesses, monitors and evaluates patient outcomes to determine changes to service plan
• Discharges services once the patient’s goals and outcomes have been achieved and links patient/family to alternative resources as appropriate
• Provides input related to caseload utilization of Ontario Health atHome resources
• Documents all aspects of patient service delivery according to Ontario Health atHome policy
• Acts as a liaison to ensure seamless coordination of services
• Participates in the development of and adherence to team and individual workload metrics
• Escalates potential high-risk events to reporting manager
• Communicate with all members included in the Circle of Care to ensure seamless transitions
• Supports the ability of the client/family to manage self-manage

What must you have?

• Membership, in good standing, with the applicable regulatory body:
  • College of Nurses of Ontario (RN's only)
  • College of Physiotherapists of Ontario
  • College of Occupational Therapists of Ontario
  • Ontario College of Social Workers and Social Service Workers
  • College of Audiologists and Speech Language Pathologists of Ontario
• 3 to 5 years of recent experience in children's health with a focus on children and youth with medical complexity and high risk/high utilization conditions.
• Understanding of Ontario’s provincial supports and strategies available for children with medical complexity and other conditions e.g. Complex Care Kids Ontario;
  Ministry of Health, Ministry of Children, Community and Social Services, and Ministry of Education.
• Experienced and knowledgeable regarding community services and resources for children and youth within Mississauga Halton geography.
• Clinical expertise providing patient and family-centred care, including critical thinking, ethical decision-making, and an ability to collaborate with a variety of different stakeholders including tertiary hospitals, community partner providers, primary care providers and school staff, to…