Integrated Clinical Specialist : Complex and Chronic Care

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

Job summary

A leading healthcare provider in Ontario is seeking an Integrated Clinical Specialist to enhance integrated complex and chronic care. This role requires strong leadership, collaboration, and strategic planning skills, with a focus on quality patient care. Candidates should have a Master's degree and at least five years of clinical experience. The position includes travel across Ontario and offers attractive benefits including competitive salary, health coverage, and professional growth opportunities.

Benefits

Competitive salary

Comprehensive health and dental benefits

Flexible work from home arrangements

Professional growth opportunities

Employee Assistance Program

Qualifications

• Registered Health Professional with expertise in complex and chronic care programs.
• Minimum five years' experience leading clinical practice initiatives in healthcare.
• Experience with knowledge translation and program management.
• Strong understanding of change management principles.

Responsibilities

• Advance Standards of Care and Professional Practice in Complex and Chronic Care.
• Champion patient-centred, high-quality care.
• Lead co-design and evaluation of complex care programs.
• Collaborate with patient care teams to improve clinical outcomes.

Skills

Leadership

Collaboration

Strategic planning

Communication skills

Organizational skills

Education

Master’s Degree in a related field

Tools

Microsoft Office Suite

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, incorporating socioeconomic determinants of health, culture, environment, and patient behaviour.

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

1. Advance Standards of Care and Professional Practice in Complex and Chronic Care
2. Champion a culture committed to patient-centred, high-quality, and integrated care, and identify transformative opportunities to enable point-of-care excellence in every patient and caregiver interaction.
3. 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.
4. Reinforce the inclusion of socio-economic, cultural, and environmental dimensions as essential components of person-specific care and clinical decision-making.
5. Elevate knowledge of chronicity and complexity beyond standard care and health outcomes.
6. Use a proactive approach for early identification and ongoing support of vulnerable populations.
7. Lead the co-design, implementation, and evaluation of complex & chronic care programs at local branches, aligning with current standards, evidence-based practices, organizational needs, and external requirements.
8. Collaborate with interprofessional patient care teams, operations, and quality and professional practice leadership to support strategies that improve clinical outcomes, including wound care from a population health perspective.
9. Promote education in multimorbidity and person-specific care planning.
10. 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).
11. Maintain clinical competency for front-line teams in chronic disease management principles.
12. Utilize instructional design principles to develop, deliver, and coordinate education on complex and chronic care.
13. Develop and implement coaching and mentoring programs to ensure best practices.
14. Provide expertise in complex and chronic disease management to diverse populations.
15. Facilitate and champion innovative practices aligned with CarePartners research initiatives.
16. Participate in developing, maintaining, and monitoring quality practice indicators to ensure ongoing fidelity to best practices.
17. Participate in the on-call rotation for remote support with members of the clinical practice specialist team.

Build Capability and Education

1. Provide consultancy and support to leadership and frontline staff to promote excellence in practice and programming, in accordance with CarePartners' standards.
2. Support consistency in complex and chronic care practices across branches.
3. Collaborate with operations, learning and development, and quality and risk leadership on initiatives such as clinical orientation, role development, and competency development.
4. Serve as a resource to facilitate full scope of practice for team members.
5. Contribute to performance appraisals and evaluations for nurses related to complex and chronic care.
6. Champion the use of digital learning platforms and identify infrastructure needs for agile, responsive learning.
7. Support training and coaching initiatives informed by key performance indicators like patient experience, outcomes, and risk events.
8. Use instructional design principles to develop, deliver, and coordinate education programs on complex and chronic care.
9. Design educational curricula on complex and chronic care, integrating adult learning principles.
10. Assist in developing communication content, including clinical updates and newsletters.
11. Incorporate adult education principles into all education programs.

Research and Policy

1. Identify and participate in research opportunities relevant to complex and chronic care.
2. Provide evidence-based clinical input for policy development and implementation related to nursing, therapy, and personal support services.
3. Attend conferences, contribute to abstract writing, and present on topics related to complex and chronic care.

Special Projects

1. Provide leadership in strategic projects and programming from a professional practice perspective.
2. Lead and participate in project teams and committees as assigned.
3. 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 in healthcare, with home and community care experience an asset.
• Experience with knowledge translation, social prescribing, and program management required.
• Experience with senior-friendly care frameworks and specialized geriatric programming.
• Practical knowledge of depression scales and assessments.
• Knowledge of social prescribing and pediatric chronic care is an asset.
• Skilled in developing content for best practice pathways and skills training.
• Strong understanding of change management principles and performance evaluation.
• Proven ability to collaborate with stakeholders and excellent organizational, communication, problem-solving, and presentation skills.
• Strong written communication, proofreading, and editing skills.
• Ability to multitask with attention to detail, prioritize, and meet deadlines.
• Proficiency in Microsoft Office Suite (Word, PowerPoint, Excel).
• Ability to handle sensitive and confidential information appropriately.
• Ability to travel within Ontario occasionally.
• Valid driver’s license, own vehicle, and insurance.

CarePartners In Your Community

CarePartners provides home-based health care, clinics, transitional care units, and relief in retirement homes and shared care settings, serving communities with limited access to healthcare since 2009.

Accessibility

CarePartners encourages applicants with disabilities and provides accommodations upon request during the hiring process.