Care Coordinator/Coach, Regional Integrated Care (Cornwall area-Hybrid)

Full-Time Indeterminate

South-East Ottawa Community Health Centre (SEOCHC) is a non-profit, community-governed organization that provides a range of multi-disciplinary services to clients, including primary care, health promotion, social services, community and resource development, and advocacy to address the social determinants of health. Our services and programs are designed to meet the needs of our community.

We are seeking a bilingual, experienced, and skilled individual to join our team as the full-time Care Coordinator/Coach in our Regional Integrated Care program. This role is integrated into the local health system to support socially vulnerable and medically complex clients with developing a coordinated care plan centred on client goals in collaboration with the care team (i.e., circle of care). This program aims to enhance the experience with the health and social service systems and improve health outcomes by building capacity and implementing standardized practices for integrated care coordination.

DUTIES AND RESPONSIBILITIES

As the care-coordinated/coach, you will manage a caseload of clients within and around the Cornwall area and work with local health and social services systems to support socially vulnerable and medically complex clients and their families to develop a coordinated care plan based on the goals/priorities of the client. The role also involves coaching the client to develop health literacy and self-management goals and providing support to adjust the care plan, centering the clients goals and needs. At times, there may be a need for case management and system navigation to support the work. This role is critical in improving patient transitions within the health care system by encouraging collaboration and coordination between members of the clients circle of care and by advocating for clients across the continuum of care.

QUALIFICATIONS:

• Regulated health care professional licensed to practice in Ontario (OT, PT, RN, RPN, RSW, RD, etc.)
• Post-secondary education in health and social sciences (Occupational Therapy, Nursing, Social Work, Physiotherapy, Nutrition, etc.)
• 3 5 years of experience in a community and/or primary care setting that includes care coordination and care planning, health coaching, client counseling, case management, and/or discharge planning.
• Background in clinical practice, social work, and/or community health with experience performing a comprehensive health or symptom-directed assessment and synthesizing data from multiple sources
• Experience serving those living with mental health and substance use
• Ability to solve problems and adapt to changing circumstances within the work environment and effectively support change.
• Ability to mentor and coach dispersed partners front-line staff in adopting new tools and methodologies.
• Ability to function as change agents and implement change management activities to ensure the integrity and quality of processes are standardized
• Demonstrated understanding of the social determinants of health and their impact on clients training in Non-Violent Crisis Intervention, First Aid & CPR, MI training, ASSIST, etc.
• Fluency in English and French is required; other languages are an asset.

Salary: $66,466 to $78,205/annum, commensurate with experience. Includes benefits and is HOOPP eligible.

At SEOCHC we are committed to diversity, equity and inclusion. We welcome applicants with diverse gender identities, sexual orientations, disabilities, and/or ethno-racial status that reflect the broad community we serve.

At SEOCHC we are committed to diversity, equity and inclusion. We welcome applicants with diverse gender identities, sexual orientations, disabilities, and/or ethno-racial status that reflect the broad community we serve.

Letters of Application, including your resume and cover letter outlining your interest/motivation and key competencies for this role, must be received by 4:00 pm Friday, June 27th, 2025.

Attn: Human Resources

South-East Ottawa CHC

Thank you for your interest. Only candidates selected for an interview will be contacted. The Centre is committed to employment equity. SEOCHC will provide accommodation for applicants with disabilities in its recruitment process. If at any stage in the selection process you require accommodation due to disability, please let us know the nature of the required accommodation.