Home Care Specialist

VHA Home HealthCare (VHA) is one of the largest not-for-profit home care providers in Ontario. Our team is made up of close to 3,000 caring and committed professionals who love what they do. Our providers tell us: “Home care is where I can truly make a difference. There is such a sense of accomplishment from helping people live independently at home.” Our teams work together to provide high quality, client-centred care to those who need it most in their homes, schools, retirement homes and other community settings. Many of our team members manage their own schedules in the community and they say, “The freedom and flexibility can’t be beat.” Providers form meaningful bonds with the clients and families they serve over time and are supported by a diverse regional team and beneficial home office programs. Team members tell us “I love the inclusive culture. I feel welcome and at home.” Pay RangeCommensurate with ExperienceThe Home Care Specialist will provide care coordination, case management, and system navigation services to clients enrolled in the , Hospital to Home and OHT-lead programs/projects and other integrated care programs. This role plays a key part in supporting clients through their transition from hospital to home and continues to provide case management throughout their participation in the program. Acting as a liaison between home care clients, hospital partners, primary care and community care teams, the Home Care Specialist ensures continuity of care and alignment with program objectives. The position also fosters strong collaboration with program funders to enable smooth, client-centered transitions, while contributing to quality improvement efforts aimed at optimizing patient flow, care coordination, and service delivery within the programs. #INVHACorp #LI-MD1If you're a Registered Nurse (RN) with CNO, this opportunity is for youKey Areas of Accountability:Coordinates services within the clients home, community, delivery and pick up of medical equipment and supplies as needed based on program-specific workflowsConduct occasional hospital visits to support hospital discharge planning or participate in case conferences for complex casesConducts home visits with the client following program-specific timelines to complete comprehensive assessments in partnership with the program funder, client and family to inform the development client goals within the program and an individualized client care planArranges and adjusts home care services according to the care plan and in alignment with services contained within the program bundleMonitors appropriate service allocation and bundle managementAttends program huddles with internal teams, hospital partners and/or program fundersArranges appointments and liaise with the client’s primary care provider within set program specific timelines, supports the client to connect with primary care when requiredCompletes documentation after encounters with clients and their care team and communicates any risk-related events to the VHA team in a timely mannerCompletes referrals to appropriate community services when needed and facilitates a seamless and supporting transition to these servicesProvides direct care to the client and trains staff on delegated acts as requiredMonitors program metrics and participates in program evaluation and process improvementKey skills, experience and behaviours required for this position:Undergraduate degree in Nursing (RN Required)5+ years of experience in home and community health or a related fieldMember, in good standing with College of Nurses of OntarioKnowledge of the health care delivery system including hospital discharge planning, home and community care, and support servicesExcellent skills in case management, coordinating care within interdisciplinary teams, interRAI assessments and navigation of community servicesExcellent assessment and decision-making skillsPassion for excellent customer service and customer experienceEffective 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 resolutionMust be available for on-call supportA valid driver’s license and access to a reliable vehicleWhat makes VHA’s compensation unique?Benefits and pension plan for permanent eligible employeesCompensation for education and professional developmentVHA is a leading learning organization so we can provide you with comprehensive orientation and training at the start and throughout your careerMentorship and peer supportCareer development opportunitiesEmployee and family assistance programWellness resourcesPerks & discountsStaff & service provider eventsAccommodation and VHA’s commitment to DEIAt VHA Home HealthCare (VHA), we passionately strive to uphold our commitments to being an Equal Opportunity Employer. We champion inclusion and diversity in all parts of our organization and are strong believers that a diverse workforce is key to the ongoing and future success of VHA. We aim to review all applicants with fair and unbiased recruitment practices where opportunities are presented based on merits, skills, and experience. VHA is committed to providing reasonable accommodation and our services are accessible and sensitive to the needs of diverse groups. I