FRENCH LANGUAGE SKILL REQUIREMENT:

N/A

POSITION SUMMARY:

The Clinical Coordinator – H2H WW (CC-WW) is responsible for facilitating the effective navigation of client centered case management, and the coordination of services, in cooperation with other care partners. This role effectively leverages the internal integrated care teams, and external care providers, through the use of technology, effective communication, organizational and leadership skills. The CC-WW coordinates client care effectively in order to help optimize client outcomes, costs and to ensure seamless transitions from hospital to community. This role assists in the ongoing community coordination of client case loads, demonstrates clinical expertise and leadership, advises on best practice and SJHC’s policies /procedures and monitors quality of services to ensure client satisfaction. The CC-WW facilitates and collaborates in the areas of leaning, info sharing, direction, guidance and implementation protocols with external care partners.
The Clinical Coordinator – H2H WW supports the Executive Director, Director Clinical Programs, Clinical Managers, clinical care team, and various other H2H WW team members with the provision of high-quality client care and the effective operations of the H2H WW program. This role assists Clients through their health journey by way of collaborative and compassionate communications and support.
The CC-WW may also assist with other H2H programs, or another clinical program needs as required.

KEY EDUCAITON AND EXPERIENCE

• Bachelor of Science Nursing (RN), or college diploma in Practical Nursing (RPN) from an accredited university or college, or equivalate education plus work experience, required
• Current and unrestricted regulated care provider in good standing with their governing body, required
• 3-5 years experience in this role or related clinical role, preferred
• 3-5 years experience in a community health care setting, preferred
• Previous experience in client case management, preferred
• A current Ontario driver’s license in good standing, required
• Proven ability in utilizing MS office, Office 365, and other software including excel spreadsheets, required
• Knowledge of community service providers, integrated models of care, preferred
• Familiar with medical record software, preferred
  St. Joseph’s Home Care is an equal opportunity employer, committed to equity, inclusiveness, and diversity across all our programs, practices, facilities, and team. AI is not used in our recruitment processes for the selection of candidates.
  If you require any accommodations during the recruitment process, such as alternate formats of materials or accessible meeting rooms, please inform the hiring manager before your interview. Should you wish to conduct your interview in French, kindly contact our head office to arrange this in advance.
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Clinical

• Facilitating a smooth and effective transition from hospital back into the community
• Following clients through the various care settings to ensure continuity of care
• Assessing client service needs. Providing input into care planning. Advising on the intake of new clients
• Acting as a liaison between clients and providers in other community support services
• Ensuring all components of a client’s care are available for both the client and their care team
• Acting as an advocate for clients/caregivers through information sharing, communications and effective decision making
• Acting as Subject Matter Expert for client case coordination
• Working collaboratively with inter-professional teams, family members, support networks, and both formal and informal service providers
• Identifying and facilitating access to the right community services from the most appropriate service providers
• Assisting nursing staff with development, initiating and coordinating individualized or standardized care for clients
• Ensuring client service are delivered effectively, efficiently, in a timely manner, and with the goal of high-quality client care
• Facilitating the effective and appropriate exchange of knowledge relating to the respective health conditions
• Facilitating client understanding of the continuum of services and resources available
• Supporting and encouraging client self management of care
• Providing input into program interpretation/education to community agency staff, physicians, clients and their families
• Providing on going resource management and discharge planning as appropriate

Operational

• Participating in joint visits with nurses in the field to perform audits and visual observations
• Acting as a resource for SJHC staff, and to external care partners, in relation to the Program and client population
• Working closely with front line nursing teams, PSW’s and office staff to assist in the resolution of day to day issues
• In cooperation with the Leadership team, providing professional and clinical guidance and leadership to all staff
• In cooperation with the Leadership team, scheduling and conducting in-service educational sessions with field staff
• In cooperation with the Program Assistants, assessing and coordinating case referrals and nursing assignments based on availability, seniority, nursing skills and client needs
• Assisting the Leadership team in ensuring that client and system level objectives of the bundled care model are meet
• Assisting with various program events (eg, meetings, team building, training etc)
• Participating in team Huddles and ensuring staff receive education and support information, feedback and communications
• Facilitating positive communication between staff, management team members, community partners, and client groups
• Maintaining high levels of confidentiality, ensuing documentation and sensitive information is kept in a secure and controlled manner
• Supporting the orientation and on-boarding of new employees, as requested
• Maintaining high levels of team motivation, and commitment to the delivery of the program objectives
• Maintaining high levels of team work, integrity, and confidentiality among program staff

Corporate

• Assisting in the collection and reporting of key program data indicators, as well as the generation and distribution of various reports, trend analysis, and other information as required or requested
• Assisting in the generation of regular (monthly, quarterly etc) reports for the Leadership group, assisting in the population of the H2H WW Scorecard data, working cooperatively with other managers or team members in generating required data
• Participating in the development of new models of care and of continuous improvement / quality initiatives
• Participating in the evaluation of integrated care delivery
• Monitoring and evaluation of program information, data, metrics, reports and trends, as related to role
• Participating in the evaluation and implementation of various program quality improvement initiatives, reviewing and recommending continuous improvement opportunities
• Participating in the strategic planning process, recommending goals and objectives for the program, participating in the implementation and monitoring of the established direction at the program level
• Assisting in the review, development, evaluation and implementation of the program component of the quality improvement and/or corporate risk mitigation strategies
• Participating in various SJHC committees as required, sharing knowledge and expertise, representing the program in various discussion groups
• Maintaining compliance to policy, procedure, safety and all applicable legislative requirements at all times
• Actively and positively promoting SJHC as a quality service provide
• Maintaining compliance to corporate training requirement (Surge, in-class etc)
• Other duties as required