Transitions Care Lead

Found in: beBee jobs CA - 1 week ago

Richmond Hill, Ontario, Canada Saint Elizabeth Health Care Full time

About the Role

An exciting leadership role within hospital transitional programs working with closely with hospitals to transition and reintegrate clients back into the community.

As a member of the Acute Transitions leadership team, you are passionate about informing and shaping the transition from hospital to home and being at the forefront of healthcare innovation in Canada.

Hybrid role (virtual /in-person) covering Newmarket and surrounding areas.

Hours are primarily during business hours Monday-Friday and can also be irregular and include on-call to support operational requirements.

As the Transitions Care Lead You will provide exemplary leadership and care flow management between the hospital partners and community care teams while ensuring excellence in the provision of client care and the achievement of corporate/program objectives. This exciting position will manage relations and collaborate with hospitals to ensure a smooth and seamless transition to a client's home environment. Additionally this position will help to ensure performance targets are met and be involved in quality improvement initiatives as it relates to optimizing patient flow and management processes within the Acute Transition programs.

Main responsibilities:

  • Act as the primary point of contact for the hospital navigator/coordinator
  • Receive, monitor and update the client tracking/notification/flow tools
  • Receive, review, and accept referrals for in-home transition services
  • Coordinate/Liaise with hospital navigator/coordinator and SE @home Team as required.
  • Participate in hospital discharge care conference for complex clients as required
  • Prepare an initial care plan (e.g. for 48-72 hours post transition) and place an initial equipment and supplies order as required
  • Ensure all necessary referral documents (e.g. transition request form, medical orders, consult notes, allied health reports) and initial care plan instructions are received by SE @Home Team
  • Attend program huddles with hospital (as per contract requirements)
  • Monitor and communicate significant deviations from the care plan to the hospital as required.
  • Communicate to the hospital any risk-related events
  • Monitor timely completion and reporting outcomes of patient/family care conferences to partner hospital(required in contract)Monitor Program Metrics (e.g. client experience, time to first visit, service volumes, risk events, etc.)
  • Facilitate risk management as per established policies and procedures
  • Communicate patient and family complaints or issues back to partner hospital and share associated action plans in partner meetings
  • Participate in program evaluation and process improvement
  • On-call as required for programs support
  • Other duties to ensure program is running smoothly

Requirements:

  • 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.

  • 3+ years of recent experience in community health or a related field.
  • Knowledge of the health care delivery system including hospital discharge planning, community care and support services
  • Excellent skills in case management and coordinating care within interdisciplinary teams
  • Excellent assessment and decision-making skills
  • Passion for excellent customer service and customer experience
  • Demonstrates strong critical thinking, problem-solving and self-directed skills.
  • Excellent interpersonal communication, and presentation skills with a diverse group or stakeholders (hospital partners, front line staff, management team)
  • Effective time management skills, with the ability to work independently and co-operatively in a busy multidisciplinary environment in various settings (e.g. at the hospital, in the office, in the community).
  • Advanced skills in Microsoft Office (Word, Excel, PPT, Visio) and comfort with learning/working with new and emerging technologies (e.g. remote patient monitoring/virtual care technologies, EHR systems, reporting systems)
  • A valid driver's license and access to a reliable vehicle.

About Us:

At SE, we love what we do. Every day, we bring hope and happiness to clients, homes, and communities across Canada. We treat each person with dignity and love, like our own family; we build empathy; and we do the right thing. We are always inspired to make a difference. As a not-for-profit social enterprise, we share knowledge, provide the best care, and help each client to realize their most meaningful goals for health and wellbeing. We are an inclusive workplace offering competitive pay, benefits, pension, and work life balance. We're a great place to work, and we hope you'll join our team.

In the interest of the health and safety of our patients/clients, employees, and greater good of public health, SE Health requires those that wish to work for this organization to be fully vaccinated against COVID-19. Fully vaccinated means a person has received both doses of the COVID-19 vaccine and it has been 14 days since the last dose.

SE Health is committed to the success of all its employees. If you feel you need accommodations because of illness or disability, please do not hesitate to contact the Talent Acquisition team at at your earliest convenience

  • Registered Practical Nurse

    Found in: beBee jobs CA - 6 days ago

    Richmond Hill, Ontario, Canada Saint Elizabeth Health Care Full time

    We are looking to hire Registered Practical Nurses (RPNs) to join our Transitions team - this is an exciting opportunity to be at the front-line of health care innovation in Canada.POSITION SUMMARY:We are seeking several dynamic, passionate Registered Practical Nurses (RPNs), who want to be part of the transformational change in home and community care by...

  • Registered Nurse

    Found in: beBee jobs CA - 6 days ago

    Richmond Hill, Ontario, Canada Saint Elizabeth Health Care Full time

    We are currently hiring Full-Time and Part-Time Registered Nurses (RN), Community/Home Care in North York/Markham/Stouffville/Richmond Hill area. Offering sign on bonus $2000We are seeking a dynamic, passionate Registered Nurse (RN), who wants to be part of the transformational change in home and community care by providing care in a truly client-centered...

  • Registered Nurse

    Found in: beBee jobs CA - 6 days ago

    Richmond Hill, Ontario, Canada Saint Elizabeth Health Care Full time

    We are currently hiring Full and Part-Time Registered Nurse (RN) for community opportunities in Newmarket, Bradford, Holland Landing, Mt Albert and Schomberg area. Offering sign on bonus $2000 We are seeking several dynamic, passionate full and part-time (days, evening, night shifts) Registered Nurses (RNs) for Newmarket, Bradford, Holland Landing, Mt...

  • Registered Nurse

    Found in: beBee jobs CA - 1 week ago

    Richmond Hill, Ontario, Canada SE Health Full time

    We are looking to hire Registered Nurses (RNs) to join our Transitions team - this is an exciting opportunity to be at the front-line of health care innovation in CanadaPOSITION SUMMARY:We are seeking a dynamic and passionate Registered Nurse (RN), who want to be part of the transformational change in home and community care by providing care in a truly...

  • Home Support Supervisor

    Found in: beBee jobs CA - 1 week ago

    Richmond Hill, Ontario, Canada Spectrum Health Care Full time

    Leads a team of Personal Support Workers to provide qualified personal care to patients in a home settingTravel to patient's homes in community and facility settingsWork collaboratively with multidisciplinary teams in community and facility settingsAssesses patient needs, according to the timeframe established by contractual agreements, formulates the plan...

  • Process Lead

    Found in: beBee jobs CA - 1 week ago

    Richmond Hill, Ontario, Canada Randstad Canada Full time

    ​Welcome home At Cascades, Sustainable Development means Respecting the True Nature of our 10,000 talents. We put you first: Flex and connected mode (telecommuting, flexible schedule) Profit sharing planTelemedecine, Group insurance and pension plan with company contributions Accessible gym space or annual flexible reimbursement program Employee...

  • Senior Lead Hand

    Found in: beBee jobs CA - 1 week ago

    Richmond Hill, Ontario, Canada Randstad Canada Full time

    Welcome home At Cascades, Sustainable Development means Respecting the True Nature of our 10,000 talents. We put you first: Salary range for Senior Lead Hand form $25 - $26 (Based on experience)Schedule 2nd shift (Monday to Friday) 3:30pm - 11pm Profit sharing planTelemedecine, Group insurance and pension plan with company contributions Employee assistance...

  • LensCrafters - Team Lead

    Found in: beBee jobs CA - 6 days ago

    Richmond Hill, Ontario, Canada EssilorLuxottica Full time

    LensCrafters - Team LeadDate: Apr 23, 2024Brand: LensCraftersLocation:Richmond Hill, ON, CA, L4C 5G2Requisition ID: 843972Store # : LensCraftersPosition: Part-TimeTotal Rewards: Benefits/Incentive Information )At LensCrafters, we're passionate about bringing people better sight. And it takes thousands of people from all backgrounds to do this.By joining our...

  • Nanny

    Found in: beBee jobs CA - 1 week ago

    Richmond Hill, Ontario, Canada CanadianNanny Full time

    Welcome My wife and I have an adorable 9 month old daughter named Leena and a 3 year old named Rayya. The four of us live in North York. We're interested in meeting someone to care for our 9 month old, who cares about education for young children, who is outgoing and motivated to do fun activities, who we can build a strong relationship with, and who has...

  • Registered Nurse

    Found in: beBee jobs CA - 1 week ago

    Richmond Hill, Ontario, Canada SE Health Full time

    We are currently hiring Full and Part-Time Registered Nurse (RN) for community opportunities in Newmarket, Bradford, Holland Landing, Mt Albert and Schomberg area.Offering sign on bonus $2000This Nursing position is part of the Community Commitment Program for Nurses (CCPN) which provides a $25,000 incentive to eligible nurses in exchange for a 24-month...

  • Nanny

    Found in: beBee jobs CA - 9 hours ago

    Richmond Hill, Ontario, Canada CanadianNanny Full time

    Hello My small family and I are looking for an experienced nanny for a part-time, live-out job in Toronto, Ontario. We would like someone part time to start, with potential for full-time as the months go by. No students please We're looking for someone who has more years of experience with babies.Our son is 6 months old, and we're hoping to hire someone...

  • Chief Financial Officer

    Found in: beBee jobs CA - 1 week ago

    Richmond Hill, Ontario, Canada RideCo Inc. Full time

    RideCo is a venture backed high-tech firm that has achieved product-market fit and is in the scale-up growth phase. We are seeking an experienced Chief Financial Officer (CFO) to join our management team. The CFO will partner with the Founder/CEO and the leadership team to achieve ambitious growth targets while ensuring financial health and sustainability...

  • Registered Practical Nurse

    Found in: beBee jobs CA - 1 week ago

    Richmond Hill, Ontario, Canada Bayshore HealthCare Full time

    Make "being the difference" your Career. .Bayshore is looking for passionate and caring Full-Time Registered Practical Nurses/Licensed Practical Nurses to join our amazing Weston Gardens Transitional Care Unit at our North York location.You will use your clinical skills to ensure that our clients receive the highest quality home health care, they need and...

  • Clinical Nurse Specialist

    Found in: beBee jobs CA - 1 week ago

    Richmond Hill, Ontario, Canada North York General Hospital Full time

    Company BioIMAGINE a hospital where everyone is committed to excellence. We did. We are. From boardroom to bedside, we go above and beyond to offer the best and safest patient care. At North York General Hospital (NYGH), we put our patients first in everything we do. We are achieving a new standard of excellence in integrated patient-centered care and as one...

  • Registered Nurse

    Found in: beBee jobs CA - 1 week ago

    Richmond Hill, Ontario, Canada Bayshore HealthCare Full time

    Bayshore HealthCare is one of the Canada's leading providers of home and community health care services and is a privately owned company. Bayshore HealthCare is proud to showcase its achievement as a Platinum member of Canada's Best Managed Companies Program every year since 2006. In 2015, Bayshore achieved the designation for Best Practice Spotlight...

  • Amended - Business Advisor

    Found in: beBee jobs CA - 1 week ago

    Richmond Hill, Ontario, Canada Ministry of Health Full time

    Are you passionate about leveraging data to drive strategic decisions in the healthcare sector? Do you thrive on providing expert guidance in developing and supporting health data reporting standards for the Ontario healthcare system? If so, we have an exciting opportunity for youAs a Business Advisor within our Health Data Branch, you will play a pivotal...

  • Organizational change manager

    Found in: beBee jobs CA - 1 week ago

    Richmond Hill, Ontario, Canada Compugen Inc. Full time

    Starting date : 1 position to fill as soon as possible About Compugen Compugen is one of Canada's largest privately-owned Information Technology (IT) Solution Providers. We help customers design, acquire, integrate and operate technology. Our mission is to help organizations realize new possibilities. Every day, our dedicated staff across North America...

  • Registered Massage Therapist

    Found in: beBee jobs CA - 2 weeks ago

    Richmond Hill, Ontario, Canada CBI Health Group Full time

    Registered Massage Therapist - Richmond Hill, ON CBI Health is Canada's leading community healthcare provider, and our passionate team is at the heart of what we do. Every day, our 13,000 staff make a meaningful difference in our clients' lives as we live the core values that define us: heart, respect, reliability, teamwork and innovation. Along with...

  • Dispatch Coordinator

    Found in: beBee jobs CA - 6 days ago

    Richmond Hill, Ontario, Canada BDO Recruitment Services - Canada Full time

    About UsAddressing overwhelming debt can be tough to manage for individuals and businesses collectively. It is important to work towards resolving debt-related challenges in a structured and manageable manner. Consulting a Licensed Insolvency Trustee will ensure you receive credible and regulated advice to help guide you down the financial rehabilitation...

  • RN - Casual

    Found in: beBee jobs CA - 1 week ago

    Richmond Hill, Ontario, Canada Bayshore HealthCare Full time

    Bayshore HealthCare is one of the Canada's leading providers of home and community health care services and is a privately owned company. Bayshore HealthCare is proud to showcase its achievement as a Platinum member of Canada's Best Managed Companies Program every year since 2006. In 2015, Bayshore achieved the designation for Best Practice Spotlight...