Facilitator role at UHN, coordinating telemedicine care for complex patients with primary care providers. Utilizing clinical expertise to prevent avoidable emergency visits and hospitalizations.
Responsibilities
Proactively sources and pre-screens referrals for patient consultations
Assist in the identification of patients who meet the criteria to participate in the IMPACT PLUS program
Initiate patient contact within 2 days of receiving a referral
Gather and organize health information to share across transitions in care
Performs client intake and provide a comprehensive clinical assessment of the patient based on pre-established criteria
Validate, analyze, and interpret information gathered to provide a recommendation of clinical resources required
Ensures the patient, their primary caregiver, and/or family physician are scheduled for the clinic/session within 30 days of the initial referral
Coordinates case conference and participates in the development of the care plan in collaboration with primary care practitioners
Participates in the orientation, training, and education process in this model of care
Supports program development and evaluation, and the sharing of research and knowledge
Ensure all documentation is completed as required for physician records, financial purposes, or as required by individual Health Links
Requirements
Completion of a bachelor's degree in either Nursing, an Allied Health Profession, or a recognized equivalent
At minimum 4 years up to and including 6 years practical and related experience and/or on-the-job training
Valid Ontario Driver's License with access to own vehicle
Solid knowledge of health care related legislation and practices and collaborative patient service delivery
Ability to think strategically to provide the best health care services for eligible patients and alternatives for those ineligible
Demonstrated in-depth expertise regarding care of vulnerable clients, including those with complex co-morbidities and chronic mental health challenges
Sound knowledge of and skill with adult education techniques
Highly developed information technology and computer skills
Case Management Certificate, an asset
Experience with telemedicine use, an asset
Experience in geriatrics/primary care/community health, an asset
Benefits
Competitive offer packages
Government organization and a member of the Healthcare of Ontario Pension Plan (HOOPP)
Close access to Transit and UHN shuttle service
A flexible work environment
Opportunities for development and promotions within a large organization
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