Lead hospital-to-home transitions for SE Health as a hybrid Transitions Care Lead using care coordination and discharge planning expertise.

This leadership position manages care flow between hospital partners and community care teams. You will accept referrals, coordinate in-home transition services, and support personalized initial care plans. The work also includes monitoring outcomes, risk events, and program performance.

Key Responsibilities:

- Act as primary contact for hospital navigators and coordinators
- Review and accept referrals for in-home transition services
- Prepare initial care plans and equipment orders
- Monitor care-plan deviations and communicate risks to hospitals
- Participate in evaluation and process improvement initiatives

Requirements:

- Regulatory membership with an applicable Ontario qualified college
- Three or more years of recent community health experience
- Knowledge of hospital discharge planning and community care
- Excellent case management, assessment, and decision-making skills
- Valid driver’s licence and access to a reliable vehicle

Apply care coordination, critical thinking, and partnership skills to improve transitions between hospitals, community teams, and home.

📌 Transitions Care Lead Hospital Liaison (Canada)
🏢 SEHC
📍 Canada