Care Coordinator, Temporary Full Time, Palliative, Labelle

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 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.

What will you do? The Care Coordinator, Palliative Care is responsible for, or supports other Care Coordinators in managing, a caseload of palliative patients who are at different stages of illness trajectories and may require a palliative approach to care. The Care Coordinator, through home visits and/or phone conversations, measures the patient’s and caregiver’s care needs and develops, implements, and updates (as required) a care plan that is informed by the patient’s and caregiver’s wishes and preferences.

He/she assists the patient and caregiver in navigating the health care system and also determines eligibility and refers to other community resources and programs, such as Hospice care and the Regional Palliative Consultation Team.

Primary Responsibilities

Completes comprehensive patient assessments using a validated palliative assessment tool, including patient’s clinical, physical and psychosocial needs, and caregiver needs

Assesses patient’s Palliative Performance Scale and eligibility for palliative and other services

Assesses eligibility for hospice care and admission to palliative care units

Develops 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

Discusses plans for end-of-life care, goals of care and preferred place of death

Coordinates and facilitates referrals and transfers to hospice and palliative care units

Assists patients and caregivers in finding in-home palliative medical follow up and coverage

Initiates and authorizes the implementation of the care plan through contracted providers, supplies and equipment necessary to achieve the care goals

Maintains open communication with service providers, conducts case conferences and regular home visits to optimize care planning and appropriate services

Partners with the Ontario Health atHome/Ottawa Hospital Medical Assistance in Dying (MAiD) Care Coordinator for those clients wanting and requiring assistance with MAiD.

Team/Department: Palliative Team

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

FTE: 1.0

Starting Salary: $44.480/hr to $47.517

Affiliation: ONA

Reporting to: Manager Patient Services

Office Location: Labelle

Length of Temporary Assignment: May 14, 2027

What must you have?

Registered Nurse (BScN or diploma) with a current Certificate of Registration from the College of Nurses of Ontario

Related professional nursing experience which is normally attained over a period of two years

Palliative care experience that includes advance care planning, goals of care and end of life care planning

Professional experience in health care should include linkage with other community health agencies, needs assessment, care coordination and/or discharge planning

Canadian Nurses Association Certification in Hospice Palliative Care is an asset

LEAP training is an asset

Experience providing MAiD expertise are assets

Ability to speak Frencgh and English is required

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?

Knowledge

Knowledge of medical diagnoses and prognoses, symptom management, end-of-life care and cognitive/psychiatric disorders

Knowledge of Champlain region Hospice and palliative care organizations and partners

Knowledge of Hospice palliative care philosophy and approach

Working knowledge of computer software (email, internet) and Microsoft Office applications (Word, Excel, Power Point, etc.)

Skills and Abilities

Effective planning, organizing, and evaluation skills to manage multiple patients, provide information reports, and take corrective action as required

Ability to accurately complete required documentation, reports, forms, and recommendations

Verbal and written communication skills to establish and maintain a wide range of partners (doctors, nurses, social workers, etc.) within the healthcare and Hospice community

Ability to manages difficult conversations /situations such as advance care planning, goals of care, end-of-life and hospice care, and medical assistance in dying, in a healthy and effective manner

Vulnerable Sector Check completed within the last six months

Hours of Work

Monday to Friday – 8:30am to 4:30pm (35hrs/week)

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​

Salary: $44.480 to $47.517

Who are we?

We are Ontario Health atHome, ready to serve every person in Ontario. We partner with patients and caregivers, family physicians, hospitals, long-term care and retirement homes, service providers and Ontario Health Teams, to deliver responsive, accessible, integ