Discharge Specialist

Reporting to the Manager of the Satellite Health Facility, the Transitional Care/Discharge Specialist is a health professional who takes a leadership consultant role in the development and implementation of comprehensive plan of community care for complex cases and quality improvement work related to our ALC work plan with HCCSS and HHS. The role provides clinical consultation around complex discharge planning. Other responsibilities include: constantly evaluating the community care needs of patients within an interdisciplinary framework in order to achieve an individualized, safe and well-coordinated discharge plan; determining ongoing medical, technological, rehabilitative, psychosocial and financial resource needs; negotiating with community service providers to ensure optimal delivery of community resources; evaluating outcomes to ensure quality and continuity of care; and effectively utilizing resources to achieve cost-effective health care. The Transitional Care and Discharge Specialist integrates research and practice and creates, utilizes and disseminates knowledge.

1. Regulated Health Care Professional in good standing with regulatory College
2. Master’s Degree preferred
3. Minimum 5 years of recent demonstrated experience in acute, post-acute and community care including: clinical expertise, resource management, continuous quality improvement methodology, case management and discharge planning
4. Minimum 5 years of recent demonstrated experience working with seniors; patients living with dementia, frailty, developmental delays, acquired brain injuries, mental health and/or substance use conditions; patients impacted by SDOH
5. Excellent knowledge of health and social services supports within the Hamilton Niagara Haldimand Brant Region
6. Demonstrated knowledge of adult education principles
7. Excellent communication, time management and organizational skills
8. Excellent critical thinking, problem solving, decision making and conflict resolution skills
9. Demonstrated willingness and ability to learn new skills and support change management
10. Demonstrated dedication to continuing education
11. Computer office support software including databases, spreadsheets and presentation software
12. Basic knowledge of utilization management including CMG’s, EDD, LOS and benchmarking
13. Knowledge and understanding of legislation governing health care delivery
14. Fluency in English (verbal and written)
15. Computer literacy and basic proficiency required