Care Coordinator, Temporary Full Time, Congregate - Ottawa, Canada - Home and Community Care Support Services Champlain

Home and Community Care Support Services Champlain

Verified Company

Ottawa, Canada

1 week ago

Posted by:

Sophia Lee

beBee Recruiter

Full time

Description

Home and Community Care Support Services Champlain is one of 14 Home and Community Care Support Services organizations in Ontario.

We are dedicated to ensuring our more than 64,000 patients annually receive the highest-quality health care and services at home.

Our patient-care coordination teams help develop care plans for people of most ages, focused on maintaining each patient's independence and dignity.

We also provide long-term care home placement services, and facilitate our patients' access to the community-based services they need.

Position Summary:

Under the general direction of the Manager, Home and Community Care, the Care Coordinator acts as a single point of contact to improve collaboration and communication in congregate settings, including retirement homes.

The Care Coordinator, through home visits and phone conversations, assesses the patient's care needs and develops, implements, and updates (as required) a care plan that is informed by the patient's health and psychosocial needs; and, where possible, accommodates patient and caregiver wishes.

He/she also determines eligibility for and arranges for HCCSS-approved health care services and refers patients and caregivers to other community resources and programs.

As a member of the Congregate Care Team, the Care Coordinator plays an integral role in Retirement Homes or Aging in Place buildings.

Care Coordinators partner closely with patients, families, caregivers, service providers and other community health and social service providers to support patients in their home environment.

The Care Coordinator regularly participates and provides guidance in meetings with key stakeholders involved at each site and fosters active direct engagement with patients and their care partners.

Primary Responsibilities:

Completes comprehensive patient assessments using a validated assessment tool, including patient's clinical, physical and psychosocial needs, and caregiver needs
Assesses the patient's and caregiver's understanding of, and learning needs related to diagnosis, treatment, available resources, illness adjustment, and coping mechanisms
Assists patient and caregiver in setting appropriate goals (individual, joint, short or long term)
Collaborates with patient, caregiver and the care team to develop an individualized care and service plan reflective of the patient's identified priorities and desired outcomes; identifies strategies and resources to be used in attaining clinical outcomes
Coordinates the delivery of home and community care services to patients and their caregivers
Coordinates vendor and resource utilization involving medical equipment, supplies and services
Facilitates understanding and cooperation among members of the patient's multidisciplinary healthcare team; communicates with members of the patient's health care team to maximize patient outcomes
Initiates and authorizes the implementation of the care plan through contracted providers
Provides regular reports to Physicians, service providers, patients, caregivers and other authorized parties as required
Case documentation in accordance with Champlain HCCSS policies

Education and Experience:

Registered Nurse (BScN or diploma) and registered with the College of Nurses of Ontario; or
Degree or diploma in Physiotherapy and registered with the College of Physiotherapy of Ontario; or
Degree or diploma in Occupational Therapy and registered with the College of Occupational Therapy of Ontario; or
Degree in Social Work and registered with the Ontario College of Social Workers and Social Service Workers; or
Degree in Speech Therapy and registered with the College of Audiologists and Speech-Language Pathologists of Ontario; or
Degree in Foods and Nutrition or equivalent and registered with College of Dietitians of Ontario.
Related professional experience (community based experience preferred) which is normally attained over a period of two years

Knowledge:

Knowledge of medical diagnoses and prognoses, symptom management, and cognitive/psychiatric disorders
Knowledge of case management principles and best practices
Knowledgeable about resource availability, service costs, budgetary parameters
Knowledge of relevant health care legislation
Knowledge of care delivery in congregate settings

Skills and Abilities:

Works with diverse patient groups with varying levels of comprehension and language capability
Manages difficult conversations/situations such as advance care planning and goals of care in a healthy and effective manner
Works effectively in both a team environment and independently as required
Verbal and written communication skills to establish working relationships and maintain a wide range of partners (doctors, nurses, social workers, etc.) within the healthcare community
Listening and facilitation skills to work with patients and their caregivers
Diplomacy in dealing with sensitive and/