Halton@Home Patient Care Navigator

Halton Healthcare; Oakville; On-site; CAD 64,802,000 - 84,006,000; Full time

Job summary

Halton Healthcare is seeking a Halton@Home Patient Care Navigator to support patients with complex health and social needs as they transition from hospital to home. You will work with an interdisciplinary team to deliver compassionate, patient-centered care and ensure timely access to required supports.

In this role you’ll coordinate discharges, develop care plans, and advocate for patients while collaborating with families and community partners to optimize outcomes and reduce readmissions.

Qualifications

• Be registered in Ontario health body; bachelor’s required.
• Masters preferred; strong case management skills.
• 2–5 years hospital and community health experience.

Responsibilities

• Coordinate transitions to home and ensure timely discharge from hospital.
• Develop, implement and monitor personalized care plans with patients and families.
• Advocate for patients and coordinate with community service providers for resources.

Skills

Care navigation

Discharge planning

Team collaboration

Community resources

English fluency

Education

Bachelor's degree in a Health Discipline

Master's degree in a Health Discipline

Regulatory body in Ontario

Tools

EMR systems

Meditech

CHRIS

Microsoft 365

Job description

• Shift Schedule (Hours are subject to change based on operational needs): Monday to Sunday - Various rotating 8 and 12 hours shifts
• Employment Status: Temporary Full-time
• Department: OT Home Case Mgmt
• Length of temporary contract: Approx. 1 year
• Site Location: Multi-Site (Oakville, Milton, Georgetown)

Company Description

Halton Healthcare’s vision of Exemplary patient experiences, always, goes beyond just the patient experience; it has shaped our entire culture and remains at the core of every interaction in our organization, from our patients & families to our staff, physicians and volunteers.

At Halton Healthcare you will thrive in a healthcare culture and environment that embraces inclusion, diversity and belonging with ‘exemplary patient care, always’ at the heart of everything we do.

We empower our people to be the very best they can be so they can make a difference for our patients and the communities we serve.

Halton Healthcaretakes great pride in providing quality, compassionate healthcare services to our rapidly growing communities. As a progressive and vibrant healthcare organization, we arecommitted to being an innovative center of excellence in community hospital care.

Job Description

Be a key part of the Community Integration and Primary Health Care Program by helping patients with complex health and social needs transition seamlessly from hospital to home. As a Halton@Home Patient Care Navigator, you’ll collaborate with an interdisciplinary team, provide compassionate care, and ensure that patients receive the right support at the right time. Your work will directly impact patient outcomes, reduce hospital readmissions, and contribute to a strong, community-focused health care system.

What You’ll Do:

• Coordinate Transitions to Home: Identify and assess patients eligible for the Halton@Home Program, ensuring timely discharge and smooth transitions from hospital to community care.
• Create Patient-Centered Care Plans: Develop, implement, and monitor personalized care plans in collaboration with patients, families, and our dedicated health care team. Recommend and facilitate the multi-disciplinary supports needed to meet the patient's needs in the community.
• Advocate for Patients: Act as a liaison between patients, families, and community service providers, ensuring they have the resources and support needed for a successful recovery at home. Monitor service delivery andfollow up after discharge to identify and address opportunities.
• Contribute to Program Growth: Share your insights and ideas to help evolve the Halton@Home Program, improving patient care and community resources through continuous feedback and collaboration.
• Collaborate Across the Community: Build strong relationships with community organizations, primary care providers, and home care services to ensure a coordinated, patient-focused approach to care.

Qualifications

Halton Healthcare endeavors to hire individuals who are competent in their chosen profession and who exemplify our mission, vision and values of accountability, respect and compassion which guide our individual behaviours and attitudes.

Professional Registration:

• Bachelors degree in a Health Discipline is required
• Masters degree in a Health Discipline is preferred
• Current membership in good standing with a regulatory health professional body in Ontario

Work Experience:

• 2–5 years of recent work experience in a hospital setting, with liaison experience in community health settings.
• 3 years of recent related experience in Emergency Department (ED), acute care, post acute care, discharge planning, and/or community health care settings.
• Experience in performing case management or care navigation functions, particularly in acute, post acute, and community settings.
• Demonstrated knowledge and expertise related to a variety of health, functional and social challenges, particularly in areas such as geriatrics, chronic disease management, complex family systems, and the care of the frail elderly.
• Evidence of program design and resource development skills, including knowledge of evaluation methodologies.

Knowledge and Competencies:

• Comprehensive knowledge of community resources and health care delivery systems across acute and community settings.
• Demonstrated ability to respond to patients with flexibility, adaptability, and a commitment to patient-centered, holistic care.
• Strong understanding of collaborative practices, including building relationshipsinternally and with community partners.

Skills and Attributes:

• Demonstrated ability to work independently and collaboratively with interdisciplinary teams, family members, support networks, and a variety of formal and informal service providers.
• Strong leadership skills, including problem-solving, critical thinking, conflict resolution, and negotiation abilities.
• Excellent interpersonal, communication, organizational, and decision-making skills.
• Exceptional time management and stress management skills.
• Comfortable working in an evolving program with changing responsibilities over time.
• Fluency in English (verbal and written).

Technical Skills:

• Proficiency in electronic medical record (EMR) systems; experience with Meditech and CHRIS (preferred).
• Computer literacy and proficiency required. This includes, but is not limited to proficiency with Microsoft 365 applications (eg Outlook, Excel, Word, Powerpoint, Sharepoint, OneDrive, etc).

Additional Information

Hours:Monday - Sunday, Various rotating 8 and 12 hours shifts, days, evenings (Hours subject to change based on operational requirements)

Salary: $47.039 to $60.979 per hour

Date Posted:October 13, 2026

REF4250Z

Halton Healthcare is an equal opportunity employer who is committed to integrating diversity, equity and inclusion throughout our operations, policies and culture.

Please note that while this job is posted on Halton Healthcare's career page, it may also appear on third-party job boards. These external platforms may use automated tools, including artificial intelligence, for candidate screening and matching.

Halton Healthcare is committed to providing accommodations for applicants with disabilities. In accordance with the Accessibility for Ontarians with Disabilities Act and the Ontario Human Rights Code, Halton Healthcare will provide accommodations throughout the recruitment and selection process. If you require an accommodation, we will work with you to meet your accommodation needs to ensure your equal participation.

The Ontario Public Hospitals Actmandates that hospitals establish health surveillance programs for all individuals working within the hospital.This regulation requires proof of immunity for certain diseases and as a result, Halton Healthcare requires all new hires to receive pre-employment medical clearance by our Health, Safety & Wellness team, prior to their start date, as a condition of employment. This includes demonstrating compliance with Halton Healthcare’s Immunization Policies.

All new hires must be fully compliant with our Vaccination Policy as a condition of employment with Halton Healthcare. Successful applicants will be required to provide proof of vaccination or proof of a documented medical exemption as part of the hiring process.

All personal information is collected under the authority of the Freedom of Information and Protection of Privacy Act.