Integrated Primary Care Coordinator

Carefirst Seniors & Community Services Association•Toronto, ON

1d•CA$60,000 - CA$75,000•Hybrid

About The Position

The Carefirst Family Health Team (FHT) is seeking a full-time permanent Integrated Primary Care Coordinator to join their innovative, interdisciplinary team dedicated to delivering high-quality, community-based care. Carefirst FHT is committed to delivering exceptional, comprehensive primary care through a collaborative, team-based model that includes family physicians, nurse practitioners, nurses, social workers, service navigators, dieticians, physiotherapists, and medical receptionists. They have a robust Chronic Disease Management and Prevention program, including a Diabetes Education Program, and are actively involved in many of the Ontario Health Team’s primary care initiatives. Their “Hub & Spoke Model” and strong community partnerships ensure coordinated, high-quality, patient‑centred care across the continuum. They work closely with Carefirst Seniors & Community Services Association to provide truly integrated services. On‑site & Integrated Programs/Services include: Ontario Health atHome (formerly Home and Community Care Support Services), MINT Memory Clinic, Ontario Structured Psychotherapy (OSP) Program, and Specialist Clinics: psychiatry, cardiology, endocrinology, optometry, geriatric medicine, gynecology, chiropody, rheumatology, physiotherapy, and audiology. The team operates four well-established clinics across Scarborough, Markham, Richmond Hill and Stouffville, and continues to expand in Markham to support continued growth and community needs. Employees will be assigned to a location that aligns with the operation needs, with occasional rotation to support clinic operations. This position is a new role at the Family Health Team. As a primary care coordinator, you will be part of the Carefirst Family Health Team while working as an integral member of the EYRND OHT. The goals of the position are to locate unattached individuals in the EYRND communities and connect them to ongoing primary care. Additionally, this individual will improve the communication and collaboration amongst primary care organizations throughout the community, including Carefirst Family Health Team, Markham Family Health Team, Health For All Family Health Team and their partners to create a more unified and stronger system. This position will serve as a liaison between various internal and external stakeholders. The successful candidate must have excellent communication and interpersonal skills and experience interacting with patients, general public, and health care providers. You will work in a team with the EYRND OHT to develop, plan, and execute strategies related to primary care navigation, attachment and engagement. Working with project managers from EYRND OHT, you will conduct community facing activities with audiences including community organizations, primary care, and the general public. You will connect with individual community members and partners, support navigation to the most fitting primary care resources, and work with partnering primary care practices to facilitate primary care attachment. You will also have the opportunity to participate in ongoing program development and quality improvement activities. The Eastern York Region North Durham Ontario Health Team (EYRND OHT) unites primary care, acute care, and community partners — including Carefirst Family Health Team, Markham Family Health Team Physicians, and Health For All Family Health Team — to strengthen patient attachment to primary care and improve collaboration across the local health system for enhanced patient-centerd care in the local communities of Markham, Stouffville, Thornhill, Brock and Uxbridge.

Requirements

5 years relevant experience is preferred
Undergraduate degree in a health-related field; having a clinical background is an asset; Master degree is considered an asset.
Experience with physician and community engagement
Strong knowledge of Ontario health care system is an asset
Excellent communication and interpersonal skills, with the ability to adapt to different audiences and build relationships with health care providers and other stakeholders
Actively takes advantage of change opportunities and recommends new or revised strategies
Actively identifies efficiencies for project implementations
Demonstration of continuing education and professional development
Demonstrated good attendance and performance records with the ability to maintain these same standards
Strong analytical skills and experience with project reporting (i.e. project risk, data, etc.)
Excellent facilitation, decision making and conflict management skills.
Solution oriented with the ability to identify problems, determine escalations as required, propose solutions, and follow through with implementing accepted solutions
Ability to be flexible and creative and take different approaches to relationship management.
Fluency in English (verbal and written) is required; ability to communicate in additional languages is considered an asset
Demonstrates initiative and the ability to function both independently and as a team member
Demonstrates a commitment to a healthy and safe workplace for self and others (staff, patients, families, etc.) by taking all reasonable precautions and working in compliance with organizations related policies, health and safety legislation and best practices and completing relevant mandatory education as required
Valid vulnerable sector police record check, completed within one year
A valid driver’s license and access to dependable transportation is essential for community outreach or engagement related activities

Nice To Haves

having a clinical background is an asset
Master degree is considered an asset
Strong knowledge of Ontario health care system is an asset
ability to communicate in additional languages is considered an asset

Responsibilities

Contribute to primary care attachment by developing, planning, and executing strategies to identify unattached patients, including working closely with Health Care Connect.
Act as a key contact and resource for community service providers, and/or the public for primary care navigation and attachment.
Participate in community engagement and outreach events.
Collaborate closely with all Ontario Health Team partners including the acute care partner and its emergency department in identifying and connecting with unattached patients.
Coordinate with participating partners to identify eligible patients, refer to primary care practices, and follow-up as required.
Develop and maintain partnerships in support of region-wide primary care strategies that responds to evolving local population health needs.
Support with gathering and reporting the progress of primary care projects and milestones.
Support partnering practices as required to deliver on the reporting obligations set out in partnership agreements.
Other project coordination activities as identified.
Support physician engagement and recruitment to participate in primary care priorities.
Support communications for primary care providers.
Other primary care engagement activities as identified.
Perform other duties and projects as assigned.