Care Coordinator, Bilingual, Temporary Full Time, Eastern Champlain South: Cornwall

Job Description

Are you an experienced registered nurse, physiotherapist, occupational therapist, social worker, dietitian, 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 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-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?

• 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 in-person visits, 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 at Home Champlain-approved health care services and refers patients and caregivers to other community resources and programs.
• As a member of the Community Care Team, the Care Coordinator will provide a broad scope of connection in their caseload geography, linking with care and services beyond community care while partnering closely with patients, families, caregivers, service providers, and other community health providers supporting the patient in their home environment.
• The Care Coordinator may also provide support to Primary Care teams strengthening the relationship and improving communication and access to care for shared patients as well as new patients.

Primary Responsibilities:

• 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 at Home Champlain policies.

Length of Temporary Assignment: May 30, 2025

Team/Department: Eastern Champlain South

Hours of work: Monday to Friday, 8:30am to 4:30pm

FTE: 1.0

Starting Salary: $43.184/hr to $46.133

Reports To: Manager, Patient Services

Affiliation: OPSEU

Office Location: Cornwall

What must you have?

• Membership, in good standing, with the applicable regulatory body:
• College of Nurses of Ontario
• College of Physiotherapists of Ontario
• College of Occupational Therapists of Ontario
• Ontario College of Social Workers and Social Service Workers
• College of Dietitians of Ontario
• College of Audiologists and Speech Language Pathologists of Ontario
• 2+ years of recent experience in community health or a related field.
• Knowledge of the health care delivery system and community resources.
• Excellent interpersonal, communication, assessment, problem-solving, and decision-making skills.
• Effective time management, prioritization and organizational skills, with the ability to work independently and co-operatively in a busy multidisciplinary environment.
• Established ability to accurately complete required documentation, reports, and forms.
• A valid driver’s licence and access to a reliable vehicle.
• Proficient in a Windows environment.
• We have a mandatory COVID-19 vaccination policy. As a condition of employment, all employees are required to submit proof of COVID-19 vaccination status prior to start date.

What would give you the edge?

• Experience working with diverse patient groups, e.g., multicultural, homeless, palliative, acquired brain injury (ABI), mental health, geriatrics, pediatrics.
• Case management experience or recent related community experience.
• Ability to speak French or another second language.

What do we offer?

We know wellness is supported with work-life balance. In an inclusive culture committed to support your passion for continuous learning, growth, and innovation, we offer:

• Attractive comprehensive compensation packages and benefits.
• Valuable development opportunities.
• Membership in a world-class defined benefit pension plan.
• Wages are in accordance with the collective agreement between Home and Community Care Support Services Champlain and OPSEU and starting salaries range from $43.18/hr. - $44.64/hr.

Who we are

We are Ontario Health at Home, ready to serve every person in Ontario. We partner with patients and caregivers, primary care providers, hospitals, long-term care and retirement homes, service providers and Ontario Health Teams, to deliver responsive, accessible, integrated, patient-centred care.

If you’re interested in driving excellence in care and service delivery, and seeking an unparalleled opportunity to lead and learn, partner and connect, care and be cared for, this is your home.

Equity, Inclusion, Diversity and Anti-Racism Commitment

Ontario Health at Home is committed to a culture of equity, inclusion, diversity, and anti-racism. We are committed to attracting, engaging, and developing a workforce that reflects the diverse communities we serve. We welcome and encourage applications from all qualified applicants. Accommodations for persons with disabilities required during the recruitment process are available upon request.

We thank all applicants for their interest; however, only those selected for an interview will be contacted.