Integrated Clinical Specialist : Complex and Chronic Care

CarePartners; Barrie; On-site; CAD 80,000 - 100,000; Full time

Job summary

A leading healthcare provider in Ontario is seeking an Integrated Clinical Specialist to advance integrated complex and chronic care. The ideal candidate will provide expert guidance in multimorbidity management and collaborate with clinical teams to ensure optimal therapeutic outcomes. This full-time role offers a competitive salary, comprehensive benefits, and opportunities for professional growth in a supportive environment.

Benefits

Competitive salary

Comprehensive health and dental benefits

Flexible work from home arrangements

Opportunities for professional growth

Qualifications

• Registered Health Professional with expertise in complex and chronic care.
• Minimum five years' experience leading clinical practice initiatives.
• Experience with knowledge translation, social prescribing, and program management.

Responsibilities

• Provide expert guidance in multimorbidity and care management.
• Collaborate with clinical teams to support high-quality integrated care.
• Develop and implement coaching and mentoring programs for staff.

Skills

Complex and chronic care expertise

Excellent communication skills

Organizational skills

Problem-solving skills

Experience with social prescribing

Education

Master’s Degree in a related field

Tools

Microsoft Office Suite (Word, PowerPoint, Excel)

Job description

Overview

The Integrated Clinical Specialist in Complex and Chronic Care was established to lead and advance integrated complex and chronic care across the province. We are seeking a highly skilled, dedicated, and self-motivated individual to support the delivery of high-quality, evidence-based care. As a key member of our professional practice team, this position will focus on providing expert guidance and leadership in multimorbidity and the complexities involved in care management, including socioeconomic determinants of health, culture, environment, and patient behavior.

The Clinical Specialist will play a pivotal role in shaping interprofessional best practices across the patient care continuum, from birth through end-of-life, supporting both clinical teams and patients. This role involves close collaboration with internal and external partners to ensure optimal therapeutic outcomes. Additionally, the Clinical Specialist will serve as a subject matter expert in skill development, working alongside Clinical Practice Leads and the Learning and Development team to foster ongoing professional growth.

This is a Full-Time position that will include planned travel throughout Ontario as required.

What We Offer

• Competitive salary, comprehensive health and dental benefits
• Other employment perks such as Employee Assistance Program, Perkopolis, Rewards Points
• Flexible work from home arrangements supporting employee work-life balance
• Inspiring leadership and opportunities for professional growth
• Supportive & dedicated Safety, Health & Wellness team & Pandemic Response team
• Interprofessional collaboration with our Professional Practice, Research & Education Team

What The Role Involves

• Advance Standards of Care and Professional Practice in Complex and Chronic Care
• Champion a culture committed to patient-centered, high-quality, integrated care and the identification of transformative opportunities to enable point-of-care excellence in every patient and caregiver interaction.
• Promote and maintain the application of standards of care, best practices, and core competencies into the development of processes and policies supporting complex and chronic care in home and community settings.
• Reinforce the inclusion of socioeconomic, cultural, and environmental dimensions as essential parts of person-specific care and clinical decision-making.
• Elevate knowledge of chronicity and complexity beyond usual care and health outcomes.
• Use a proactive approach for early identification and ongoing support of vulnerable populations.
• Lead the co-design, implementation, and evaluation of the complex & chronic care program at local branches, aligning with current standards, evidence-based practices, organizational needs, and external requirements.
• Collaborate with interprofessional patient care teams, operations, and quality and professional practice leadership to support strategies that advance excellence in clinical wound care outcomes from a population health perspective.
• Promote education in multimorbidity and person-specific care planning.
• Implement evidence-based pathways and programs using an integrated care delivery approach, understanding and elevating the roles of all healthcare professionals (e.g., Personal Support, Therapies, Nursing).
• Maintain clinical competency for front-line teams in chronic disease management principles.
• Utilize instructional design concepts to develop, deliver, and coordinate education on complex and chronic care.
• Develop and implement coaching and mentoring programs for staff to ensure best practices.
• Provide expertise in complex and chronic disease management to diverse populations.
• Facilitate and champion innovative practices aligned with CarePartners research initiatives.
• Participate in developing, maintaining, and monitoring quality practice indicators to ensure ongoing fidelity.
• Participate in the on-call rotation for remote support with team members.

Build Capability and Education

• Provide consultancy and support to leadership and frontline staff to promote practice and programming excellence, in accordance with CarePartners' standards.
• Support consistency of complex and chronic care practices across branches.
• Work closely with operations, learning and development, and quality and risk leadership on initiatives like clinical orientation, role development, and competencies.
• Serve as a resource to facilitate the full scope of practice for team members.
• Contribute to performance appraisals for nurses related to complex and chronic care.
• Champion the use of digital learning platforms and identify infrastructure needs for agile, responsive learning.
• Support local training and coaching initiatives informed by key performance indicators such as patient experience, outcomes, and risk events.
• Design educational curricula on complex and chronic care, incorporating adult learning principles.
• Assist in developing communication content based on evidence-based clinical and research findings, such as updates and newsletters.
• Incorporate adult education principles into all education programs.

Research and Policy

• Identify and participate in research opportunities relevant to complex and chronic care.
• Provide evidence-based clinical input into policy development, maintenance, and implementation for nursing, therapy, and personal support services.
• Attend conferences, contribute to abstract writing, and speak at events related to complex and chronic care.

Special Projects

• Provide leadership on strategic priority projects and programming from a professional practice perspective.
• Lead and participate in internal project teams and committees as assigned.
• Perform other duties as assigned.

What You Bring

• Registered Health Professional with expertise in complex and chronic care programs such as Diabetes, COPD, CHF, Dementia, Dialysis
• Master’s Degree in a related field preferred.
• Minimum five years' experience leading clinical practice initiatives within healthcare, with home and community experience an asset.
• Experience with knowledge translation, social prescribing, and program management.
• Experience with senior-friendly care frameworks and specialized geriatric programming.
• Practical knowledge of depression scales and assessment tools.
• Knowledge of and experience with social prescribing.
• Experience with complex/chronic pediatric care is an asset.
• Skilled in researching and developing content for best practice pathways and skills training.
• Demonstrated knowledge of change management and performance evaluation principles.
• Proven ability to collaborate with stakeholders internally and externally.
• Strong organizational, communication, problem-solving, influencing, negotiation, and presentation skills.
• Excellent written communication, proofreading, and editing skills.
• Ability to multitask, prioritize, and meet deadlines with attention to detail.
• Proficiency in Microsoft Office Suite (Word, PowerPoint, Excel).
• Ability to handle sensitive and confidential information appropriately.
• Willingness and ability to travel within Ontario occasionally.
• Valid driver’s license, own vehicle, and appropriate insurance.

CarePartners In Your Community

We serve the community through clinics, transitional care units, and relief in retirement homes and shared care settings. Our outreach program has organized staff-led medical care and clinics in underserved countries since 2009.

Accessibility

CarePartners welcomes applicants with disabilities and encourages requests for accommodations at any stage of the hiring process.