Transitional Care Coordinator
2 days ago
The Transitional Care Coordinator practices in accordance with standards of professional practice and the Osler corporate mission, vision and values that support a model of inter-professional collaboration as a vehicle to facilitate practice culture and support a patient-focused model of care. The Transitional Care Coordinator supports the delivery of a superior care experience to all patients and their families by practicing as an equal member of a core team of skilled professionals working to full scope of practice to ensure that each patient has a comprehensive patient assessment, care plan and timely and effective discharge plan.
Accountabilities:
In collaboration with the inter-professional team, the Transitional Care Coordinator coordinates decision-making for patient transfer and discharge beginning at the point of admission and throughout the hospitalization:
- Screens all admissions for early identification of high-risk discharges (within 24 hours of admission) and documents accordingly
- Conducts a risk assessment using standardized tools and communicates results of the risk assessment to the inter-professional team
- Meets with the patient and family to determine pre-admission physical and mental functioning as it relates to activities of daily living
- Identifies pertinent demographic and health related information, care giver support, community resources, and any previous discharge planning assessments that may impact on the discharge plan
- Within 24 hours of a diagnosis being communicated, collaborates with the patient, family and inter-professional team to develop and implement an effective discharge plan that identifies barriers and solutions
- Initiates, arranges and facilitates case conferences for management of patient care issues such as determining families understanding of discharge clinical care needs, identifying concerns regarding services and co-ordination and identifying short and long-term goals in planning discharge
- Ensures early collaboration with the Home and Community Care Support Services case managers on all patients likely to require post discharge support
- Works in collaboration with the Home and Community Care Support Services case manager and external agencies to develop and implement the individualized plan of care to facilitate discharge and provide guidance to patients and their families pertaining to relevant community agencies to support their needs
- Collaborates daily (more frequently as required) with the inter-professional team, including the most responsible physician, to uphold and revise as necessary a timely discharge plan
- Documents and communicates discharge plans to the patient, family and the inter-professional team
- Documents assessments and other relevant information in Meditech and at bullet rounds
- Follows the patient's discharge progress through to discharge destination
- Attends bullet rounds and initiates and/or participates in identifying the expected date of discharge and mobilizing the team to work towards a common goal
- Maintains accurate records and statistical information and identifies ALC and actual length of stay information against expected length of stay
- Monitors for extended length of stay beyond the estimated date of discharge and facilitates discussion at bullet rounds to minimize or remove risks and barriers to timely discharge
- Collaborates with other discharge coordinators in developing strategies for extended length of stay at difficult to discharge rounds and communicates strategies to patient care managers
- Attends daily bed management meeting and provides updates related to the patient discharge status, transitional requirements and repatriation issues
- Provides education, communication and assistance to the patient and family as well as the inter-professional team
- Provides leadership to inter-professional team to assist patients through the health care continuum
- Identifies appropriate spokesperson for the patient if the patient is incapable of making decisions and collaborates with social worker in confirming substitute decision-maker and power of attorney
- Bachelor's Degree in a health related discipline
- Post diploma education/experience in gerontology
- Minimum three to five years recent acute care hospital and community experience
- One year experience in case management, utilization review or equivalent
- Regulated health care professional
- Member in good standing of a professional college
- Minimum one to two years in a leadership position
Hours: Currently Days/Evenings, 8 hours, including weekends and statutory holidays (subject to change in accordance with operational requirements)
Internal application deadline: March 20, 2025
#LI-GG1 #TFT
Osler values inclusivity and diversity in the workplace. We welcome and encourage applicants from diverse backgrounds. We are committed to providing accessible employment practices that are in compliance with the Accessibility for Ontarians with Disabilities Act. If you require an accommodation at any stage of the recruitment process, please notify Human Resources at human.resources@williamoslerhs.ca.
While we thank all applicants, only those selected for an interview will be contacted. Any information obtained during the course of recruitment will be used for employment recruitment purposes only, and not for any other purpose.
-
Transitional Care Coordinator
2 days ago
Brampton, Ontario, Canada William Osler Health System Full timeJob DescriptionThe Transitional Care Coordinator practices in accordance with standards of professional practice and the Osler corporate mission, vision and values that support a model of inter-professional collaboration as a vehicle to facilitate practice culture and support a patient-focused model of care. The Transitional Care Coordinator supports the...
-
Transitional Care Coordinator
3 days ago
Brampton, Ontario, Canada William Osler Health System Full timeCompany description One of Canada's Best Diversity Employers and Greater Toronto's Top Employers for many consecutive years, William Osler Health System (Osler) provides a safe and supportive health care network to grow your career. Osler is nationally recognized for its commitment to patient safety and is Accredited with Exemplary Standing, the highest...
-
Care Coordinator
3 days ago
Brampton, Ontario, Canada Home and Community Care Support Services Full timeJob Description Are you an experienced registered nurse, physiotherapist, occupational therapist, social worker (MSW), 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...
-
Patient Flow Coordinator
7 days ago
Brampton, Ontario, Canada William Osler Health System Full time**Job Description**We are seeking a highly motivated Patient Flow Coordinator to join our team at the William Osler Health System. As a key player in our healthcare delivery network, you will be responsible for coordinating patient flow across our facilities, ensuring timely and efficient care.In this role, you will work closely with our multidisciplinary...
-
supervisor, customer service transit
2 weeks ago
Brampton, Ontario, Canada City of Brampton Full timeJob DescriptionJOB TITLE: SUPERVISOR, CUSTOMER SERVICE TRANSITDEPARTMENT: TRANSITPOSTING NUMBER: 106616NUMBER OF POSITIONS: 1JOB STATUS & DURATION: Temporary 13 monthsHOURS OF WORK: 35 hour workweekLOCATION: Brampton Transit Clark Blvd.SALARY GRADE: 6HIRING SALARY RANGE: $97,593.00 - $109,792.00 per annumMAXIMUM OF SALARY RANGE: $121,991.00 per annumJOB...
-
Administrative Support Coordinator
2 days ago
Brampton, Ontario, Canada We Care International Full timeWe Care International is a nonprofit charitable organization dedicated to improving the lives of vulnerable communities through impactful programs and initiatives. We are seeking a highly organized and detail-oriented volunteer Administrative Assistant and Support Secretary to provide essential administrative support to the Secretary and the broader team.Key...
-
Care Coordinator
5 days ago
Brampton, Ontario, Canada UNAVAILABLE Full timeJob DescriptionAre you an experienced registered nurse, physiotherapist, occupational therapist, social worker (MSW), 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...
-
Brampton, Ontario, Canada City of Brampton Full timeJob DescriptionJOB TITLE: Project Leader, Transit Business Improvements & ContractsDEPARTMENT: TransitPOSTING NUMBER: 106401NUMBER OF POSITIONS: 1JOB STATUS & DURATION: Temporary 13 months contractHOURS OF WORK: 35 hour workweekLOCATION: Brampton Transit, Sandalwood PkwySALARY GRADE: 6HIRING SALARY RANGE: $97,593.00 - $109,792.00 per annumMAXIMUM OF SALARY...
-
Rapid Response Nurse
3 days ago
Brampton, Ontario, Canada Home and Community Care Support Services Full timeJob Description Are you an experienced registered nurse (BScN or diploma) looking for a different kind of practice environment, and comfortable practising both independently and as part of a team? This could be what you've been looking for. As an integral part of our Rapid Response Nursing (RRN) team, you will work with medically complex...
-
Care Partners Team Coordinator
4 days ago
Brampton, Ontario, Canada CarePartners Full timeAt CarePartners, we are committed to providing exceptional home health care services to our patients. As a Team Coordinator, you will play a vital role in ensuring the seamless delivery of our services. You will be responsible for coordinating schedules, communicating with patients and staff, and managing administrative tasks.About Our ServicesWe provide...
-
Project Coordination Specialist
4 days ago
Brampton, Ontario, Canada Soneil Electronics Full timeSoneil Electronics is hiring a Project Coordination Specialist to own end-to-end project planning, execution, and tracking for R&D and Engineering projects.Responsibilities:Define timelines, milestones, and deliverables while coordinating across teams.Implement and maintain agile workflows (e.g., sprint planning, backlog prioritization).Act as a bridge...
-
15h Left: Team Coordinator
4 days ago
Brampton, Ontario, Canada CarePartners Full timeWho We AreCarePartners is one of Ontario's largest accredited home health care providers, providing nursing, personal support, therapy and rehabilitation support services for patients of all ages. We care for approximately 72,000 patients each year in homes, schools, clinics, workplaces and retirement homes, through our 24 locations and 22 nursing clinics....
-
Therapy Care Manager
20 hours ago
Brampton, Ontario, Canada Paragon Full timeAbout UsAt Paragon, we believe that setting our employees up for success is key to delivering exceptional patient care. We provide a personalized orientation to ensure a seamless transition into our team.Job ResponsibilitiesThe successful candidate will be responsible for:• Conducting comprehensive evaluations to determine patients' physical limitations...
-
Care Coordinator Specialist
4 days ago
Brampton, Ontario, Canada UNAVAILABLE Full timeCompany OverviewAt Ontario Health atHome, we are dedicated to providing responsive, accessible, and integrated patient-centred care to every person in Ontario. We partner with patients, caregivers, primary care providers, hospitals, long-term care and retirement homes, service providers, and Ontario Health Teams to deliver high-quality care.
-
Employee Experience Coordinator
7 days ago
Brampton, Ontario, Canada William Osler Health System Full timeJob DescriptionThe Employee Experience Coordinator (EEC) provides recruitment and employee experience administrative support to the Talent Acquisition team in order to execute the end-to-end candidate job transition process and support team projects. Through exceptional communication and organization skills, the EEC partners with the team/hiring managers and...
-
Registered Nurse
3 days ago
Brampton, Ontario, Canada Home and Community Care Support Services Full timeJob Description Registered Nurse-Hospital to Home Are you an experienced registered nurse, physiotherapist, occupational therapist, social worker (MSW), 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. What will you do? ...
-
Clinical Care Coordinator
8 hours ago
Brampton, Ontario, Canada Revera Inc. Part time**Job Summary:**We are seeking a compassionate and experienced RPN to join our multi-disciplinary team. The successful candidate will be responsible for implementing and evaluating the effectiveness of care plans, completing resident assessments, and communicating changes as required.
-
Non-Profit Administrative Professional
2 days ago
Brampton, Ontario, Canada We Care International Full timeWe are seeking a reliable and skilled volunteer Administrative Assistant and Support Secretary to assist our Secretary and other staff members at We Care International. As a key member of our administration team, you will be responsible for providing essential administrative support and contributing to the smooth operation of our office.Key...
-
Brampton, Ontario, Canada We Care International Full timeJob Title: Administrative Assistant and Support Secretary (Volunteer)Department: AdministrationReports To: Secretary and Admin OfficerOrganization: We Care InternationalJob Overview:We Care International is a dedicated nonprofit charitable organization committed to improving the lives of vulnerable communities through impactful programs and initiatives. We...
-
Volunteer Office Manager Assistant
2 days ago
Brampton, Ontario, Canada We Care International Full timeWe are looking for a skilled volunteer Administrative Assistant and Support Secretary to join our team at We Care International. As a key member of our administration department, you will play a vital role in providing essential support to our Secretary and other staff members.Responsibilities:Administer various administrative tasks, including managing...