Navigator - Integrated Seniors Hub

About the Role

PCH is launching an integrated Seniors Hub aligned with our Strategic Plan and in partnership with organizations across Mississauga and the Mississauga Ontario Health Team (MOHT).

The Navigator, Integrated Seniors Hub will support the launch of an innovative, digitally enabled approach to centralized navigation and integrated, coordinated care planning. This role will leverage programs, services, and partnerships available across Mississauga and through the Integrated Seniors Hub to help seniors and their families access the right supports and services at the right time.

Key Responsibilities

• Support the development and implementation of plans to improve access to and navigation of seniors’ services, in alignment with community partners, PCH’s Strategic Plan, the Mississauga Ontario Health Team (MOHT), and applicable legislative requirements.
• Enhance workflow and communication pathways between PCH and other care providers by identifying barriers to care and developing new care pathways that promote seamless and coordinated care for patients/clients.
• Create opportunities within the Hub for community members to connect with PCH partners and build awareness of available services and supports.
• Support seniors with complex needs, including those living with dementia, by providing system navigation and coordinating access to health, social, and community services.
• Work closely with primary care providers, CarePoint Health, Primary Care Networks, patients, and caregivers to facilitate shared care planning, seamless transitions across services, and connections to appropriate resources.
• Initiate and support coordinated care plans in collaboration with Navigators and partner organizations.
• Refer community members requiring medical or other specialized supports to appropriate clinical staff and health and social service professionals.
• Build and maintain strong relationships with network partners and relevant health, social, and community service providers.
• Leverage PCH’s expertise in complex aging to enhance care integration, improve patient outcomes and experiences, and support primary care providers in managing high-needs patients within a coordinated, patient-centred model of care.
• Promote PCH programs, services, and navigation supports within the Mississauga community using a person-centred approach.
• Contribute to a safe, welcoming, non-judgmental, and comfortable care environment for patients/clients, families, and caregivers.
• Communicate effectively with patients, families, caregivers, community partners, and members of the healthcare team.
• Practice collaboratively with members of the healthcare team to provide care and support to patients/clients with complex health needs.
• Ensure practice is consistent with entry-to-practice competencies, safe practice standards, professional standards, guidelines, and applicable legislation.
• Contribute to the ongoing assessment and documentation of each patient’s health status and, as appropriate, develop and/or implement individualized Plans of Care while monitoring and evaluating their ongoing effectiveness.

Key Qualifications

• Membership in good standing with the applicable regulatory body:
  • College of Nurses of Ontario
  • College of Physiotherapists of Ontario
  • College of Occupational Therapists of Ontario
  • Ontario College of Social Workers and Social Service Workers
  • College of Audiologists and Speech-Language Pathologists of Ontario
• Minimum 2 years of recent experience in community health or a related field.
• Knowledge of the healthcare delivery system and community resources.
• Excellent interpersonal, communication, assessment, problem-solving, and decision-making skills.
• Experience in access, case management, care navigation, care coordination, or health planning is considered an asset.
• Experience working with seniors in a long-term care environment is considered an asset.
• Strong understanding of best practices in community and clinical assessments, client service approaches, and program design.
• Demonstrated ability to build and maintain strong relationships with key stakeholders, including Ministry representatives, local and provincial community partners, clients and families, and senior leaders across multiple organizations, both virtually and in person.
• Thorough understanding of community services and resources within the Mississauga Halton region.

Salary

$65,000 – $95,000 per year