Hospital to Home (H2H) Coordinator

Brant Community Healthcare System; Brantford; On-site; CAD 70,000 - 90,000; Full time

Benefits offered by this job

Competitive compensation and benefits

Job summary

Brant Community Healthcare System (BCHS) is seeking a Hospital to Home (H2H) Coordinator. You will identify eligible patients for the H2H program and act as liaison among hospital teams, home care providers, and primary care physicians to enable timely, safe discharges with a bundled care plan.

The role emphasizes collaboration with clinical and community partners, ensuring comprehensive eligibility assessments and high-quality transition care.

Qualifications

• Bachelor’s degree in OT, PT, SLP, or SW is required.
• Registered and in good standing with a regulatory body.
• 3–5 years clinical experience in acute care or rehabilitation setting.

Responsibilities

• Collaborate with community care partners and leadership to craft safe transition care plans.
• Liaise with community providers daily to support case management and patient goals.
• Complete referrals to Ontario Health@Home and Community Support Services for timely transitions.
• Support delivery of high-quality patient care experience and respond to feedback.

Skills

Interpersonal skills

Time management

Stakeholder engagement

Data interpretation

Project planning

Education

Bachelor’s degree in Occupational Therapy, Physiotherapy, Speech Language Pathology, or Social Work

Job description

Grow Your Career at Brant Community Healthcare System (BCHS)

At BCHS, we are driven by a bold vision: To Lead Beyond Care. As a two-site community hospital system in Brantford and Paris, Ontario, we serve with purpose, passion, and a deep commitment to the people who rely on us.

• Brantford General Hospital – Our acute care hospital offering a full spectrum of inpatient and outpatient services.
• The Willett in Paris – Home to our urgent care centre and transitional care services, supporting patients through every step of their healthcare journey.

With Over 130 Years Of Service, BCHS Is Evolving With a Renewed Focus On Excellence, Collaboration, And Innovation. Our Strategic Priorities Center On Quality Care, Connected Teams, And a Healthy Future For Our Patients, Our People, And Our Community. Our Culture Is Shaped By Our Core Values And Pillars

Core Values

Be Bold and Courageous | Commit to Excellence | Champion Equity | Be Trustworthy

Four Pillars

Patient-First | People-Centred | Partnership-Based | Progress-Focused

These values reflect who we are, what we stand for, and how we work together to have influence. Join us in shaping the future of healthcare—right here at BCHS.

Why Choose BCHS?

• Investing in You – Access to a centralized Education Fund, tuition support, and professional development opportunities.
• Flexible Scheduling – Within a standard work week
• Career Growth – Internal job postings, mentorship programs, and leadership development.
• Predictable Work Locations – Stability and consistency in your work environment.
• Collaborative Team Culture – Work alongside skilled professionals in a supportive, interdisciplinary setting.
• Employee Wellness Matters – Peer Support Team, Wellness Committee, Free, confidential Employee Assistance Program (EAP) for employees and their families.
• Commitment to Safety – Comprehensive safety programs for all
• Competitive Compensation and Benefits –– Salaries and benefits designed to align with industry standards, reinforcing our commitment to attracting and retaining top talent. Excellent Pension Plan.
• Diversity & Inclusion – We are actively working to diversify our teams and remove systemic barriers in hiring, retention, and advancement. We track and report on our progress because representation matters. We regularly review our benefits, policies, and programs through an equity lens to meet the needs of our diverse teams. Provide accommodations for religious practices and use trauma-informed policies that support mental wellbeing.
• Recognition & Rewards – Employee appreciation programs and professional recognition opportunities and Corporate Committee
• Community Impact – Make a real difference in patient care and public health every day.
• Choose Civility – Where every interaction matters. Civility and respect shape our workplace, as individuals treat one another—and the communities we serve with dignity, empathy, and cultural awareness. We foster a culture of civility by raising awareness, setting clear expectations, and continually reviewing our policies and practices to ensure respect is at the core of everything we do.

Position Summary

Reporting to the Clinical Manager Access & Flow, the BCHS Hospital to Home (H2H) Coordinator in collaboration with the patient, family/supports, physician, and members of the clinical team will identify eligible patients for the Hospital to Home Program. The coordinator acts as the liaison between the hospital team, the home care service provider, and the primary care physician. The aim of the program is to transition medically stable patients who have restorative potential back home with a clear, comprehensive bundled care plan of professional and personal support services.

The H2H Coordinator practices in accordance with standards of professional practice and the BCHS corporate mission, vision and values providing program oversight and ensuring identified patients have a comprehensive eligibility assessment, and a high-quality patient and family-centered transition care plan prepared to enable the safe and effective delivery of care in the patient’s home environment.

Primary Responsibilities

• Collaborate with community care partners and respective leadership to gain appropriate insights to support the creation of a safe and feasible transition care plan that will achieve the patients’ care goals within the appropriate amount of time
• Liaise with the community providers daily to provide case management support and to ensure the interventions are meeting the patients’ goals
• Complete referrals to Ontario Health@Home, and/or Community Support Services as applicable to support timely transitions from the BCHS@Home program.
• Support the delivery of, while providing a great patient care experience, receiving and responding to feedback, in collaboration with leadership and service provider partners, as applicable.

Mandatory Qualifications

• Bachelor’s degree in Occupational Therapy, Physiotherapy, Speech Language Pathology, or Social Work
• Registered and in good standing with a regulatory body
• Three to five years clinical experience in an acute care or rehabilitation healthcare setting

Mandatory Competencies

• Excellent interpersonal, communication, organizational and time management skills
• Understanding of disease progression
• In depth understanding of community resources and relevant stakeholders
• Demonstrated ability to develop and implement project plans
• Strong analytical and data interpretation skills, with experience in using data to drive decision‑making.
• Experience in stakeholder engagement and communication, with the ability to build and maintain relationships.
• Proven ability to manage multiple tasks and meet tight deadlines.
• Excellent written and oral communication skills, with the ability to present complex information clearly.
• Familiarity with industry best practices and trends in program management
• Strong problem‑solving skills and the ability to think critically and strategically.
• Experience with tools and methodologies for data collection, analysis, and reporting.
• Proficient with computer systems such as email, MS Word, MS Excel, MS PowerPoint, and other project management tools.
• Demonstrated experience working with financial decision support systems, electronic health records, and administrative information systems.
• Our Commitment to Equity, Diversity, and Inclusion

BCHS is committed to building an inclusive and accessible workplace that reflects the diversity of the communities we serve. We welcome people from all walks of life, including people of all genders, sexual orientations, racial and ethnic backgrounds, Indigenous identities, abilities, and lived experiences. Inclusion is part of how we deliver better care

We are dedicated to removing barriers and providing accommodations at every stage of the hiring process in accordance with the Accessibility for Ontarians with Disabilities Act (AODA). If you require any accommodations, please inform us when contacted, and we will work with you to meet your needs.

AI Use in Hiring

Brant Community Healthcare System does not use artificial intelligence (AI), automated tools, or algorithms to screen, assess, or rank candidates during the hiring process; all applications are reviewed by our recruitment team.

tient, worker & workplace) is a BCHS Corporate Priority. The successful applicant will demonstrate good stewardship in the identification, reporting and mitigation of unsafe acts or conditions.