Indigenous Care Coordinator

1 week ago


Thunder Bay, Canada Grand Council Treaty #3 Full time

**Grand Council Treaty #3 in partnership with Thunder Bay Regional Health Sciences Centre**

Are you passionate about improving the health and mental health outcomes of Indigenous peoples by providing culturally appropriate and safe care? Do you have experience with health system navigation and discharge planning? Grand Council Treaty #3 is currently hiring an Indigenous Care Coordinator in partnership with Thunder Bay Regional Health Sciences Centre (TBRHSC), as part of a new collaborative pilot program between Grand Council Treaty #3, Anishinabek Nation-Union of Ontario Indians (Anishinabek Nation), Anishnawbe Mushkiki and the TBRHSC.

The Indigenous Care Coordinator (ICC) is based in TBRHSC and reports to the Provincial Policy Analyst, Grand Council Treaty #3. The ICC will work as part of an interprofessional team, including other ICCs who report to Anishnawbe Mushkiki and Anishinabek Nation. The ICC will be part of TBRHSC Circle of Care Team under the supervision of the TBRHSC’s Senior Director of Indigenous Collaboration.

The ICC is responsible for providing a range of health and mental health navigation, advocacy, discharge planning and supports services to Indigenous peoples accessing health and mental health services at TBRHSC.

The goal of the program is to improve equitable access to care for Indigenous patients and support their return home through rigorous discharge planning processes and supports that leverage community/region-based services that are culturally appropriate and safe. The ICC will work with local communities to support the smooth transition of patients back to their homes as appropriate.

The ICC will primarily be responsible and accountable for care coordination in the Grand Council Treaty #3 territory area; however, the position will work with other ICCs to support continuous coverage and manageable workloads. Each ICC will be a specialist of their area as well as generalists of services available for Indigenous people throughout northwestern Ontario.

Grand Council Treaty #3 and the TBRHSC are committed to delivering healthcare in a manner that is consistent with Patient and Family Centered Care. Applicants are required to have a demonstrated knowledge, understanding and commitment to this care philosophy.

**DUTIES AND RESPONSIBILITIES**

Reporting to Grand Council Treaty #3’s Provincial Policy Analyst, and under the supervision of the TBRHSC’s Senior Director of Indigenous Collaboration and in accordance with Hospital policies, standards and procedures, the ICC is responsible for:
**Planning/Coordinating & Supports**:

- Facilitate a patient-centered discharge plan with the physician / health care practitioner (responsible for recommending discharge and any follow-up requirements), patient, family/significant others, and interprofessional team.
- Receive and process referrals and inquiries and provide clear and accurate information on available community-based services to support patients in accessing and optimizing the available services and supports.
- Participate in bed rounds to support patients, nursing staff and interprofessional team to develop appropriate plan of care and discharge plan.
- Coordinate case conferences and trial discharges for complex patient discharges.
- Support individuals and families to make necessary arrangements for assisted living, respite, and/or placement of names on waiting lists for facility care.
- Liaise with service providers and suppliers to arrange and authorize necessary services, equipment and devices, medical supplies, and transportation.
- Facilitate referrals to home and community care for alternative level of care and supportive resources (e.g. holistic healing and wellness services, mental health and addictions programs, St. Joseph’s Care Group programs and other community-based organizations, programs and services).
- Provide advocacy supports for patients and their families/support systems as required to support equitable access to quality care.
- Coordinate with psychiatrists and mental health physicians / specialists to support the needs of Indigenous patients with mental health and addictions issues, including developing an appropriate plan of care and discharge and aftercare plan.

**Organizational Responsibilities**:

- Attend quarterly meetings with Grand Council Treaty #3 management to report back on program outcomes.
- Participate in Grand Council Treaty #3 and TBRHSC-led trainings, as relevant / appropriate.
- Propose changes within the Hospital that would improve the quality of service to Indigenous patients and their families.
- Assist and support the development of specific policies or protocols for Grand Council Treaty #3 and TBRHSC to improve access and provision of culturally appropriate and safe services for Indigenous peoples.

**Leadership**:

- Foster intra/interprofessional collaborative relationships through respectful communication and knowledge of all team members’ roles and responsibilities.



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