Continuing Care Coordinator, Permanent Full-Time (1.0), Home & Community Care
About The Position
As a Care Coordinator supporting children and youth, you play a key role in delivering connected, accessible, and family‑centred care across home, school, and community settings. You are responsible for coordinating admissions to Home and Community Care (H&CC), including referrals from hospitals, other regions, and the community, as well as supporting smooth transitions following discharge from CHEO. In this role, you work across the full continuum of care—conducting comprehensive assessments and reassessments, determining service eligibility, developing and implementing care plans, coordinating services, and evaluating outcomes. You collaborate closely with children, youth, families, caregivers, interdisciplinary health care teams, schools, and community service providers to ensure timely access to appropriate supports and continuity of care. Grounded in a commitment to family‑centred and culturally responsive care, you bring a collaborative, evidence‑informed approach to supporting children and youth in their homes and communities. Availability for after‑hours on‑call support is required. This is a hybrid position requiring on-site presence at times based on operational needs.
Requirements
- Degree in Nursing, Physiotherapy, Occupational Therapy, Speech-Language Pathology, Social Work or Dietetics (Essential)
- Current registration with the appropriate regulatory College (Essential)
- At least two (2) years of related professional experience (Essential)
- Demonstrated competency in assessment of pediatric health care needs (Essential)
- Knowledge of medical diagnoses and prognoses, symptom management, and cognitive/psychiatric disorders (Essential)
- Awareness of and sensitivity to the needs of a culturally diverse population (Essential)
- Communicates effectively, orally and in writing (Essential)
- Demonstrates excellent in interpersonal skills (Essential)
- Excellent time management and organizational skills (Essential)
- Works effectively in both a team environment and independently as required (Essential)
- Diplomacy in dealing with sensitive and/or confidential issues (Essential)
- A valid driver’s license and access to a reliable vehicle (Essential)
- Vulnerable Sector Check (Level 3) (Essential)
- Bilingualism (French/English) (Essential)
Nice To Haves
- Five (5) years of related experience (Preferred)
- Related experience in a community-based setting (Preferred)
Responsibilities
- Conducts comprehensive assessments and reassessments of children and youth, working closely with patients and families/caregivers to identify care needs and determine eligibility for services.
- Develops, implements, and regularly evaluates individualized care and service plans that support needs across home and school settings.
- Supports safe and effective transitions from hospital to home by collaborating with CHEO teams, families, and service providers.
- Promote early identification of patient needs and implement discharge plans that optimize hospital and community resources.
- Maintains ongoing communication with patients, families, interdisciplinary teams, and service providers to monitor progress and adjust care plans as needed.
- Conducts follow-up to assess outcomes and ensure care plans remain responsive and effective.
- Completes documentation and maintains appropriate EPIC and CHRIS patient records in accordance with the employee’s respective regulatory College and CHEO policies and procedures.
- Attends and participates actively in team meetings and general staff meetings.
- Attends case conferences as required.
- Assumes responsibility for maintaining professional knowledge and updated skills.
- Will support other duties as assigned.
Benefits
- competitive salary and comprehensive benefits package
- unique culture that fosters dedication, communication, respect and teamwork
- place where your opinions will be respected, contributions valued and your initiatives rewarded
- family-friendly environment that supports you and your own family, as well as the children, youth and families we serve
- chance to grow — personally and professionally — through our comprehensive orientation program and on-the-job learning
- support for continued education and learning
- potential for a relocation reimbursement benefit
- truly unique work environment
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
