Care Coordinator Specialist

1 day ago


Toronto, Ontario, Canada VHA Home HealthCare Full time

VHA Home HealthCare is a forward-thinking organization that prioritizes exceptional care and unparalleled customer experiences. We believe in empowering our clients to live independently and thrive in their communities, and we're seeking a skilled and compassionate Care Coordinator Specialist to join our team.

About the Role

The Care Coordinator Specialist will be responsible for navigating the complexities of healthcare transitions, ensuring seamless communication between clients, hospitals, and community care providers. This individual will coordinate the delivery of Home Care services, medical equipment, and supplies, while also fostering strong relationships with clients, families, and healthcare professionals.

Key Responsibilities
  • Receive, review, and accept referrals for in-home transition services.
  • Act as primary point of contact for the hospital navigator/coordinator.
  • Coordinate delivery of Home Care services, medical equipment, and supplies as needed.
  • Monitor and update client tracking/notification/flow dashboards.
  • Liaise with hospital lead/OH@Home coordinator and VHA Teams as required.
  • Liaise with community support services as required.
  • Participate in hospital discharge planning meetings and client care conferences for complex clients as required.
  • Attend program huddles with hospital partners and program funders.
  • Communicate and collaborate with clients, families, members of the healthcare team, and community resources to facilitate decision-making regarding appropriate services.
  • Ensure seamless navigation of community services and Primary Care Physician connections as required by the client.
  • Provide direct care to the client and train staff on delegated acts as required.
  • Monitor timely completion and reporting outcomes of patient/family care conferences to hospital partners and program teams.
  • Communicate patient and family complaints or issues back to program leads/hospital lead, VHA team, and shares associated action plans.
  • Participate in program evaluation and process improvement.
What You'll Need
  • Diploma or Undergraduate degree in Nursing (RN Licensure is required).
  • 5+ years of experience in home and community health or a related field.
  • Member, in good standing with College of Nurses of Ontario.
  • Knowledge of the healthcare delivery system including hospital discharge planning, home and community care, and support services.
  • A valid driver's license and access to a reliable vehicle.
  • Excellent skills in case management, coordinating care within interdisciplinary teams, interRAI assessments, and navigation of community services.
  • Excellent assessment and decision-making skills.
  • Passion for excellent customer service and customer experience.
  • 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).
  • Proficient skills in Microsoft Office (Word, Excel, PPT) and comfort with learning/working with new and emerging technologies (e.g., EHR systems, reporting systems).
  • Intersectoral experience and excellent relationship-building skills and dispute resolution.


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