Job 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:To ensure effective transitions from acute to home care for frail adults and seniors with complex needs and/or high risk characteristics. To ensure communication and linkage with primary care; and provide timely and effective rapid response home care. The Rapid Response Nurse provides the first in-home nursing visit within 24 to 48 hours from hospital discharge. During this visit, the nurse will confirm the patient hospital discharge care plan, communicate the importance of primary care to avoid re-hospitalization, and perform medication reconciliation for the patient.Primary Responsibilities:

• Reviews the discharge care plan and confirms outstanding medical tests have been scheduled and transportation etc. is available
• Conducts medication reconciliation and reviews medication protocol with patients and caregivers and answers any questions
• Initiates contact with primary care physician and provides update on patient acute care event and post-discharge regime. Facilitates, as appropriate, a one-week patient follow-up visit with the primary care physician
• Identifies patients requiring an accelerated assessment and home care services and works with the Care Coordinator to facilitate the home assessment visit. In some situations, RRNs may complete an in-hospital assessment and facilitate services as required
• Informs and supports the Care Coordinator in developing the patient\'s care plan and ensuring a smooth transfer of the primary care physician and pharmacist to the ongoing care team
• Assesses for and promotes a safe environment for patients, caregivers, family members, and staff. Adheres to health and safety policies/ practices developed and implemented by the HCCSS.
• Participates in establishing, maintaining, and monitoring standards for the Case Management. This includes committee work and active participation and contribution to quality initiatives
• Other related duties may be assigned

Education and Experience:

• Registered Nurse (RN) (BScN or diploma) with a current Certificate of Registration from the College of Nurses of Ontario
• Minimum two (2) years of relevant experience performing the duties of a Registered Nurse
• Current CPR-C Certification
• Case Management Certificate is an asset

Knowledge:

• Knowledge of health care system and the role of the HCCSS within the system
• Knowledge of HCCSS operations, quality, risk, and performance management principles
• Knowledge of relevant health care legislation
• Knowledge of HCCSS policies, procedures, strategic direction and goals
• Understanding of HCCSS partners and contracted service providers in the community
• Effective planning and organizing skills to manage multiple patients, provide information reports, and take corrective action as required
• Ability to accurately complete required documentation, reports, forms, and recommendations
• Working knowledge of computer software (email, internet) and Microsoft Office applications (Word, Excel, Power Point, etc.)

Skills and Abilities:

• Strong interpersonal skills to work with diverse patient groups with varying levels of comprehension and language capability
• Strong ability to manage difficult conversations /situations in a healthy and effective manner
• Demonstrates a strong ability to work effectively in both a team environment and independently as required
• Effective communication skills to establish and maintain a wide range of contacts with professionals and organizations within the community
• Effective listening and strong facilitation skills are necessary to work with patients and their families/caregivers
• Effective organizational and planning skills
• Demonstrated awareness of cultural diversity, as well as ability to demonstrate diplomacy in sensitive and/or confidential issues.
• A valid driver\'s license and access to a vehicle is required
• Vulnerable Sector Check completed within the last six months

Affiliation: OPSEU Wages are in accordance with the collective agreement between Champlain HCCSS and OPSEU and salaries range from $40.409/hr. - $43.169/hr.Shift: A rotating shift schedule comprised of eight hour shifts with various start times between the hours of 8am and 8pm, seven days/week for a total of 70hours (scheduled to work every 3rd weekend)Location: The work location is dependent on desk space availability and may be the work location of the successful candidate or such other location as may be mutually agreed by the Employee and the Employer.This position is temporary until approximately April 2025Home and Community Care Support Services Champlain offers flexible work options, this position will have a hybrid model of work with a combination of work locations, including community and clinical settings, patients\' homes, on-site, and remote.All applications will be reviewed; however, only those selected for an interview will be contacted. Home and Community Care Support Services Champlain welcomes and encourages applications from people with disabilities. Accommodations are available on request for candidates taking part in any aspects of the selection process.Home and Community Care Support Services has implemented a mandatory vaccination policy across the province that requires all staff to be fully vaccinated against COVID-19. Applicants being considered for employment will be required to provide proof of vaccination documentation confidentially to Human Resources upon hire. Any medical or human rights exemption requests will be reviewed and validated prior to an offer of employment.

Home and Community Care Support Services