Nurse Practitioner

Overview

The Primary Care Nurse Practitioner (NP) will provide comprehensive, person-centered care within the homecare setting. The NP will be the most responsible clinician for clients who are unattached, or have challenges accessing their primary GP/NP and require clinical assessment, diagnosis, prescribing and care planning. The NP will work within an interdisciplinary team to assess clients' holistic needs, co-develop client-focused care plans, and support clients with complex social, medical, functional, and psychosocial needs during critical care transitions.

This is a hybrid role based in the Toronto Central region, with a mix of virtual and in-person care delivery depending on the patient’s needs. The NP reports to the Director of Nursing and collaborates closely with the leadership team to improve care continuity, reduce unnecessary emergency visits, and enhance clinical outcomes.

• Why join SE Health?
• Competitive Total Rewards: more than a paycheque, with benefits, pension, flexible pay options, car-loan support, housing solutions and staff perks.
• Flexibility & Belonging: hybrid work, flexible scheduling and an inclusive culture.
• Purpose & Impact: join a national social enterprise focused on health, innovation and community impact.
• Growth That Meets Your Ambition: access tuition support, training and career pathways.

• Clinical Care and Case Management: involve tiered care based on clinical judgment—from one-time consults to longitudinal follow-up.
• Conduct comprehensive assessments, order and interpret diagnostics, diagnose, prescribe medications, and implement therapeutic plans of care.
• Perform person-centered health assessments at admission, annually, and as needed, including quarterly medication reviews when the client finds a community GP/NP.
• Promote evidence-based practice through latest research-based guidelines.
• Support patients with acute exacerbations or complex health challenges, including geriatric syndromes, cognitive impairment, and mental health concerns.
• Utilize communication and counselling skills and provide client-focused health education.
• Collaborate with the community interdisciplinary team to support care escalation and maximize scope of practice across disciplines.
• Apply Primary Health Care principles within the appropriate scope of practice for individuals, groups, families and communities.
• Act as a liaison with primary care providers, specialists, and other community services to ensure coordinated care.
• Support safe transitions in and out of the program, reducing hospital readmissions and avoidable ED visits.
• Offer timely interventions when primary care is delayed or unavailable.
• Provide clinical leadership in advance care planning, symptom management, and palliative approaches as appropriate.
• Collaboration and Interdisciplinary Support: work as part of an integrated team to develop, implement and evaluate patient-centered care plans.
• Share expertise to support other providers, especially in complex or ambiguous situations.
• Promote a team-based, high-trust environment aligned with the HOPE Model of care.
• Participate in patient huddles/case conferences to discuss cases and optimize care plans.
• Quality Improvement and Program Development: identify gaps, trends and opportunities to improve patient outcomes; monitor performance indicators and support best practices.
• Collaborate in program evaluation and support implementation of innovations; participate in investigations to identify risks and drive corrective action.
• Respond to client and staff incidents and complaints per policies; promote a no-blame approach to reporting and managing incidents.
• Identify risk and health and safety issues and consult with leadership and Occupational Health and Wellness teams as required.

• Current registration with the College of Nurses of Ontario in the Extended Class (NP-Adult or NP-Primary Health Care).
• Master's Degree in Nursing/Nurse Practitioner, or MScN with post-Master’s NP diploma.
• Minimum of 5 years of clinical experience in primary care, home and community care, chronic disease management, transitional care, palliative care, or mental health.
• Demonstrated ability to…