At Get Well Family Health Team, we are committed to providing comprehensive, patient-centered primary care through an interprofessional model. Our team of physicians, nurses, interdisciplinary health professionals, and administrative staff work together to enhance the health and well-being of individuals and families in our community.

Position Summary The Community Resource Navigator provides assessment, system navigation, and advocacy to support patients and families dealing with social, emotional, financial, or mental health challenges. Working within an interprofessional primary care team, the Community Resource Navigator ensures patients receive coordinated, holistic, and culturally responsive care. This role will have resource research and navigation, case management, and some community health outreach responsibilities.

This role will be employed by Get Well Family Health Team (the home organization) and carry out responsibilities for both Get Well Family Health Team and NeighbourLink (the host organization).

Key Responsibilities

Get Well Family Health Team:

- Conduct comprehensive biopsychosocial assessments to identify patient and family needs.
- Research health, community, and social services and contribute to the development and maintenance of resource listings within the Pathways Ontario platform. Promote the use of the platform and provide education to applicable team members, health care providers, and community partners on effective use of this platform for resource navigation.
- Provide supportive case management.
- Assist patients in accessing community and government services (e.g. housing, financial aid, mental health supports, legal and settlement services).
- Provides care coordination, including advocacy, coaching, risk assessment, crisis prevention and intervention, and referrals to appropriate supports such as primary care providers, financial assistance programs, assistive devices, home and safety assessment resources, food banks and meal programs, transportation services, and social or recreational programs.Maintains accurate, up-to-date client records, case notes, and workload documentation in the EMR,



in accordance with organizational policies, professional standards, and privacy legislation.
- Develop and implement care plans in collaboration with physicians, nurses, and interdisciplinary health providers.
- Participate in case conferences, quality improvement initiatives, and program development within the Family Health Team.
- Coordinate the delivery of health workshops or FHT promotion events.
- Uphold patient confidentiality and comply with relevant legislation such as PHIPA, Mental Health Act, and the Health Care Consent Act.
- Take on additional initiatives that contribute to the growth of the Family Health Team.

Neighbourlink:

- Conduct assessments of participant needs and connect individuals to appropriate housing, income, employment, health and social supports, acting as the point of continuity across referrals.
- Provide in-person, phone, and email support to participants across NeighbourLink’s two food banks, and mobile delivery program as needed as well as our Get Help form.
- Maintain accurate records and track follow-up to support continuity of care over time.
- Stay up-to-date on current resources, eligibility criteria, and referral pathways available to assist individuals.
- Identify emerging needs and service gaps across programs to help inform future workshops or targeted programming.
- Act as a liaison between NeighbourLink and external service (healthcare providers, government agencies, and non-profits) to support referral follow-through.
- Build and maintain relationships with community partners to reduce duplication of effort and strengthen referral pathways.
- Support the team as needed, especially with large-scale events when all staff members are involved.

Qualifications

- Bachelor or Master's degree in Social Work (BSW/MSW)



an asset.
- Registered and in good standing with the Ontario College of Social Workers and Social Service Workers (OCSWSSW) an asset.
- Knowledge of social determinants of health, local community resources, and health/social systems in Ontario.
- Experience providing case management in a primary care, community health, or social services setting.
- Experience in outreach event planning and coordination is considered an asset.
- Strong interpersonal, communication, presentation, and documentation skills.
- Demonstrated ability to work independently and collaboratively in a multidisciplinary environment.
- Experience with EMR systems is considered an asset.
- Proficiency in a second language such as Mandarin, Cantonese, Korean, Farsi, Tagalog, or Spanish is a strong asset.

Why Join Us:

- Work in a supportive, collaborative, and cutting-edge primary care and interprofessional team.
- Opportunities for professional growth and continuing education.
- Make a meaningful impact on the health of our community.

Additional Job Details:

- Location: In person at Bathurst & Sheppard and North York area.
- Job Type: Full-time
- Posting Type: Newly created role
- Compensation: $25 - $32 hourly
- Benefits: Group Extended Health Care Benefits; HOOPP Pension Benefit; Free On-site parking
- Use of AI: We do not use AI in the recruitment process. The hiring team reviews and screens all resumes, and selects candidates directly for interviews and offer.

For more information about the Get Well Health Team, please visit: https://getwellteam.ca/

We thank all applicants for their interest in working for Get Well Family Health Team. However, only those selected for further consideration will be contacted.

We are committed to being an equal opportunity employer and are happy to provide accommodations upon request at all stages of the recruitment process. Should you require any disability-related accommodation to support your participation in our recruitment process, please contact us at [email protected] and we will work with you to meet your accessibility needs.

📌 Community Navigator (North York)
🏢 Get Well Family Health Team
📍 North York