Integrated Clinical Specialist : Complex and Chronic Care

CarePartners; Toronto; Hybrid; CAD 75,000 - 90,000; Full time

Job summary

A healthcare organization in Toronto seeks a Clinical Specialist in Complex and Chronic Care to provide expert guidance and leadership. The role includes promoting patient-centered care and collaborating with diverse teams across Ontario. Ideal candidates will have a Master's degree, experience in complex care programs, and strong organizational skills. This full-time position offers a competitive salary and opportunities for professional development.

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 chronic care.
• Minimum five years' experience leading clinical practice initiatives.
• Knowledge and experience with social prescribing.

Responsibilities

• Promote patient-centered, high-quality, integrated care.
• Collaborate with interprofessional patient care teams.
• Evaluate quality practice indicators to ensure fidelity.

Skills

Leadership in complex care

Communication skills

Problem-solving

Organizational skills

Knowledge in diabetes and chronic care

Education

Master's degree in a related field

Tools

Microsoft Office

Digital learning platforms

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 related to 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, and integrated care, identifying transformative opportunities to enable point-of-care excellence in every patient and caregiver interaction
• Promote and maintain application of standards of care, best practices, and core competencies in process and policy development supporting complex and chronic care in home and community settings
• Reinforce the inclusion of socioeconomic, cultural, and environmental dimensions as essential components in 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 local complex & chronic care programs aligned with current standards, evidence-based practices, organizational needs, and external requirements
• Collaborate with interprofessional patient care teams, operations, and quality leadership to support strategies that improve clinical outcomes, including wound care 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 principles 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 on complex and chronic diseases to diverse populations
• Facilitate and champion innovative practices and programs aligned with CarePartners research initiatives
• Participate in developing, monitoring, and maintaining quality practice indicators to ensure 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 program excellence according to CarePartners standards
• Support consistency of complex and chronic care practices across branches
• Work with operations, learning and development, and quality leadership on initiatives like clinical orientation, role development, and competency development
• Serve as a resource to facilitate full scope of practice for team members
• Contribute to performance appraisals and evaluations for nurses related to complex and chronic care
• Champion the use of digital learning platforms and infrastructure to enable agile learning
• Support site-specific training and coaching initiatives based on key performance indicators
• Use instructional design to develop, deliver, and coordinate education programs on complex and chronic care, incorporating adult learning principles
• Assist in developing communication content, such as clinical updates and newsletters

Research and Policy

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

Special Projects

• Bring leadership to strategic priority projects from a professional practice perspective
• Lead and participate in project teams and committees as assigned
• Perform other duties as required

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; experience in home and community care is an asset
• Experience with knowledge translation, social prescribing, and program management
• Experience with senior-friendly care frameworks and geriatric programming
• Practical knowledge of depression scales and assessments
• Knowledge 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
• Knowledge of change management principles and performance evaluation
• Proven ability to collaborate with stakeholders
• Strong organizational, communication, problem-solving, influencing, negotiation, and presentation skills
• Excellent written communication, proofreading, and editing skills
• Ability to multi-task with attention to detail, organization, prioritization, and time management skills, meeting deadlines
• Proficiency in Microsoft Office (Word, PowerPoint, Excel)
• Ability to handle sensitive and confidential information
• Willingness and ability to travel within Ontario occasionally
• Valid driver’s license, own vehicle, and appropriate insurance

CarePartners In Your Community

In addition to home-based care, CarePartners serves 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 in underserved regions since 2009.

Accessibility

CarePartners welcomes and encourages applicants with disabilities. Accommodations are available upon request at any stage of the hiring process.