Transitions Care Lead

4 days ago

Niagara Falls, Canada SE Health 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.

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.

**Full time role - Remote opportunity**

**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
- 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
- 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.

  • Transition Lead

    6 months ago

    Niagara, Canada St. Joseph's Villa - Behavioural Support Ontario (BSO) Full time

    **Position Summary** Transitional Leadership: The Transitional Lead works in collaboration with the client, family, substitute decision maker and community care providers to facilitate a holistic approach to care for persons presenting as high risk for responsive behaviours on transition to a long-term care facility. The Transitional Lead will conduct a...

  • Administrative Assistant

    6 months ago

    Niagara Falls, Canada LEAD MECHANICAL Full time

    Education: Secondary (high) school graduation certificate - Experience: Experience an asset - or equivalent experience **Tasks**: - Schedule and confirm appointments - Answer telephone and relay telephone calls and messages - Greet people and direct them to contacts or service areas - Open and distribute regular and electronic incoming mail and other...

  • Patient Care Specialist

    6 days ago

    Niagara Falls, Ontario, Canada SE Health Full time

    About the RoleWe are seeking dynamic and passionate Therapy Assistants (OTA/PTA) to join our Transitions team at SE Health, a not-for-profit social enterprise that brings hope and happiness to clients, homes, and communities across Canada.Job DescriptionAs a Therapy Assistant, you will be part of a diverse, collaborative care team providing services to...

  • Home Care Therapist

    1 day ago

    Niagara Falls, Ontario, Canada SE Health Full time

    We are seeking dynamic and passionate Therapy Assistants (OTA/PTA) to join our Transitions team at SE Health, a not-for-profit social enterprise dedicated to providing innovative healthcare solutions in Canada.Job DescriptionProvide client-centered care to individuals in the community, working collaboratively with a diverse care team to deliver holistic...

  • Social Worker

    1 week ago

    Niagara Falls, Canada SE Health Full time

    looking to hire **_Social Workers_** to join our Transitions team - this is an exciting opportunity to be at the front-line of health care innovation in Canada. ***: - We are seeking dynamic, passionate Social Workers _who want to be part of the transformational change in home and community care by providing care in a truly client-centered approach. You...

  • Care Manager

    2 months ago

    Niagara, Canada Stay at Home Nursing Care Full time

    Are you a passionate and experienced Registered Practical Nurse (RPN) or Registered Nurse (RN), ready to take the next step into a leadership role. As a Care Manager with Stay at Home Nursing, you will have the exciting opportunity to oversee a portfolio of clients, crafting personalised care plans that empower them to achieve their health goals. You'll also...

  • Bso - Care Support Worker - Niagara Region

    6 months ago

    Niagara Falls, Canada St. Joseph's Villa, Dundas Full time

    The HNHB LTCH BSO Care Support Worker will use a team approach to provide holistic care to the residents of LTCH’s to which they are referred. Their practice and non-pharmacological approach focus will be through capacity building of LTCH staff through; coaching, mentoring and modelling strategies and interventions to support the LTCH to manage and care...

  • Home Health Care Professional

    6 days ago

    Niagara Falls, Ontario, Canada SE Health Full time

    About the RoleWe are seeking dynamic, passionate Therapy Assistants (OTA/PTA) to join our Transitions team in providing care in a client-centered approach. As part of an interdisciplinary team, you will work collaboratively with other disciplines to implement care plans and assist clients in achieving their goals.Key ResponsibilitiesProvide comprehensive...

  • Experienced Dog Sitter Wanted for Pet Care Position

    1 week ago

    Burk's Falls, Ontario, Canada Care Full time

    We are seeking a qualified dog sitter to provide pet care services for our clients in the Burks Falls area.About UsCare is a leading provider of pet care services, dedicated to delivering exceptional care and attention to our furry friends.Our team of experienced pet sitters are passionate about providing a safe and nurturing environment for dogs, ensuring...

  • Dental Assistant

    6 months ago

    Niagara Falls, Canada My Care Dental Full time

    An exciting opportunity is available with My Care Dental in Niagara Falls. We are happy to be adding to our staff to join us for a Part Time position as a Dental Assistant, with possibility to lead to Full Time. Hiring for evening and weekend shifts. My Care Dental offers a health and wellness incentive and a uniform allowance. **Job Type**:...

  • Lead Hand

    2 months ago

    Regional Municipality of Niagara, Canada Voyago Full time

    Voyago is hiring a Lead Hand for our Transit Operations in the Niagara Region. Your Role Maintain paperwork and timesheets/vacations are required Perform daily circle checks on spare vehicles and are prepared to switch off broken down vehicles or complete a run-on last-minute notice Immediately report and document all injuries, collisions or property damage...

  • Therapy Assistant

    1 week ago

    Niagara Falls, Canada SE Health Full time

    We are looking to hire Therapy Assistants (OTA/PTA) 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 Therapy Assistants (OTA/PTA) who want to be part of the transformational change in home and community care by providing care...

  • Rigging Gaffer

    1 day ago

    Niagara Falls, Canada Stagevision LP Full time

    Education: Registered Apprenticeship certificate - Experience: 1 year to less than 2 years - or equivalent experience - ** Health benefits**: - Dental plan - Disability benefits - Health care plan - Paramedical services coverage - Vision care benefits - ** Other benefits**: - Free parking available - ** Support for Veterans**: - Participates in a...

  • Spiritual Care Coordinator

    6 months ago

    Niagara Falls, Canada Park Place Seniors Living Full time

    **Spiritual Care Coordinator Part Time 30 hour biweekly position** The Part Time (30 hours biweekly) Spiritual Care Coordinator manages, developes, directs and maintains a comprehensive program of services relative to spiritual and religious care for residents and their families. Respects and carries out the values associated with a person-centred approach...

  • Regional Business Development Manager

    3 weeks ago

    Niagara Falls, Ontario, Canada United Services Group Full time

    About United Services GroupWe are a reputable Canadian facility maintenance company, providing diverse services to large retail and commercial businesses nationwide.Salary & BenefitsOur competitive compensation package includes a salary of approximately $85,000 per year, along with comprehensive health, dental, and vision benefits. After one year of service,...

  • Home Health Care Nurse Specialist

    4 days ago

    Niagara Falls, Ontario, Canada Bayshore HealthCare Full time

    About Bayshore HealthcareBayshore Healthcare is a leading provider of home health care services, dedicated to delivering high-quality care to clients in the comfort of their own homes.

  • Woodworking Production Lead

    6 months ago

    Niagara Falls, Canada ChopValue Manufacturing Ltd. Full time

    The Woodworking Production Lead will report to the Director of Operations and ensure that our team operates efficiently and delivers on production targets. This role is a unique opportunity to build and lead a team of 8-16 individuals in our precision woodshop and production area. You will be responsible for full oversight of our process including;...

  • Client Care

    6 months ago

    Niagara Falls, Canada SWS Warning Lights Inc Full time

    **Job Title**:Client Care & Warranty Specialist **Reports to**: Client Experience Lead **Responsibilities**: - Delivering world-class service as a member of front-line sales team to end users, distributors, OEM’s. - Be a trusted adviser for clients, suggesting appropriate “Essentials” products, product requirements, diagnosing problems and...

  • Care Coordinator

    5 months ago

    Smiths Falls, Canada Home and Community Care Support Services Full time

    Job Description Are you an experienced registered nurse, physiotherapist, occupational therapist, social worker (RSW), 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...

  • Clinical Specialist

    6 months ago

    Niagara Falls, Canada CarePartners Full time

    Who We Are: CarePartners is one of Ontario’s largest, most reputable and well-established accredited home health care providers, providing nursing, personal support, home support, palliative, therapy and rehabilitation support services for patients of all ages across urban and rural Ontario. We visit approximately 80,000 patients each year in homes,...