Job Category: Leadership

Location: Newmarket ON

Job Type: Temporary (Fixed Term), Full time

Number of Positions: 1

Minimum – Maximum Hourly Rate: $64.94 – $77.20

Why Join Our Team?

A people-first workplace environment that prioritizes belonging, wellness, and psychological safety. Hybrid, virtual, and in-person working environment (where applicable). Progressive health and dental benefit plans. HOOPP pension plan with employer and employee premium sharing. Enhanced wellness initiatives, including virtual fitness classes and on‑site gym memberships.

About the role

The Clinical Coordinator is responsible for identifying, screening and coordinating patients who continue to require hospital-level acute care but can be safely managed at home through the Acute Care @ Home program. The Clinical Coordinator supports the entire patient journey from identification and referral through screening, intake, consent, eligibility assessment, transfer home, active care, discharge and transition. Working closely with patients, families, physicians, and interdisciplinary teams, the Clinical Coordinator ensures safe, timely, and coordinated movement through the program. This role also supports program evaluation through accurate documentation, data collection, and monitoring of key performance indicators.

What you bring

- Bachelor of Science in Nursing (BScN) required.
- Current Registered Nurse (RN) registration in positive standing with the College of Nurses of Ontario.
- Minimum two (2) years of recent discharge planning and care coordination experience within an acute care hospital setting.
- Minimum two (2) years of experience working within an @Home, hospital-to-home or comparable acute/transitional care program.




- Solid knowledge of acute care patient flow, discharge planning, transitions of care and community-based services.
- Demonstrated experience with patient identification, screening, intake, eligibility assessment and transition planning.
- Demonstrated ability to coordinate complex patient transitions from hospital to home.
- Strong clinical assessment, critical‑thinking, problem‑solving and decision‑making skills.
- Excellent communication and interpersonal skills with the ability to collaborate effectively with patients, families, physicians and interdisciplinary teams.
- Strong organizational and time‑management skills with the ability to manage multiple referrals and competing priorities.
- Demonstrated ability to work independently and make timely decisions in a fast‑paced environment.
- Strong electronic documentation, computer and data collection skills.
- Experience collecting, monitoring and reporting program metrics and key performance indicators.
- Demonstrated commitment to patient‑ and family‑centered care, patient safety, quality improvement and teamwork.

What you’ll be doing

- Proactively identifies and screens patients who may be eligible for Acute Care @ Home.
- Reviews referrals and completes clinical eligibility assessments in collaboration with the interdisciplinary team.
- Coordinates patient referral, intake,



consent and admission processes.
- Educates patients and families about the program and confirms their readiness and suitability for care at home.
- Coordinates transfer planning, ensuring required medications, equipment, diagnostics and clinical services are arranged.
- Facilitates timely communication and clinical handover between hospital and community teams.
- Acts as a key liaison between patients, families, physicians and interdisciplinary care providers.
- Coordinates individualized care plans and addresses barriers that may delay transfer home.
- Monitors patient progression through the program and supports ongoing care coordination.
- Identifies clinical or operational concerns and escalates appropriately to the Acute Care Charge Nurse and/or most responsible provider.
- Initiates discharge planning early and coordinates timely transition once hospital-level acute care is no longer required.
- Ensures appropriate follow‑up services and clinical handover are arranged at discharge.
- Maintains accurate and timely documentation throughout the patient’s episode of care.
- Collects, validates and tracks program data and key performance indicators, including referrals, eligibility, admissions, length of stay, escalations, discharge outcomes and other required metrics.
- Supports program evaluation, quality improvement and identification of opportunities to improve patient flow and outcomes.
- Participates in the development and refinement of clinical pathways, workflows and processes for the Acute Care @ Home program.
- Performs other duties as assigned by the Manager or delegate.

Southlake Health Culture a

📌 Clinical Coordinator, Acute@Home (Newmarket)
🏢 Southlake Health
📍 Newmarket