Integrated Clinical Specialist : Complex and Chronic Care

CarePartners; Windsor; Hybrid; CAD 80,000 - 100,000; Full time

Job summary

A leading healthcare provider in Windsor, Canada, seeks an Integrated Clinical Specialist to enhance chronic care practices. You will support high-quality care delivery, collaborate with diverse teams, and implement best practices. Candidates should have extensive experience in clinical initiatives, preferably with a Master's degree. This role offers competitive benefits, flexible work arrangements, and an opportunity for professional growth.

Benefits

Competitive salary

Comprehensive health and dental benefits

Employee Assistance Program

Flexible work from home arrangements

Inspiring leadership

Qualifications

• Minimum five years' experience leading clinical practice initiatives in healthcare.
• Practical knowledge of depression scales and assessments.
• Familiarity with social prescribing and complex/chronic pediatric care.

Responsibilities

• Support the delivery of high-quality, evidence-based care.
• Champion patient-centred, integrated care.
• Collaborate with interprofessional care teams to improve clinical outcomes.

Skills

Registered Health Professional

Experience with Diabetes and COPD

Strong organizational skills

Excellent written communication

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 complexity this brings to the management of care, including the incorporation of 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

• Advance standards of care and professional practice in complex and chronic care
• Champion a culture committed to patient-centred, high-quality, and integrated care, identifying 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 processes and policies supporting complex and chronic care in home and community settings
• Reinforce the inclusion of socioeconomic, cultural, and environmental dimensions as essential components 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 complex & chronic care programs at local branches, aligning with current standards, evidence-based practices, organizational needs, and external requirements
• Collaborate with interprofessional care teams, operations, and quality and professional practice leaders 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 concepts to develop, deliver, and coordinate education on complex and chronic care
• Develop and implement coaching and mentoring programs to ensure best practice delivery
• Provide expertise on complex and chronic diseases to diverse populations
• Facilitate and champion innovative practices and programming aligned with CarePartners research initiatives
• Participate in developing, maintaining, and monitoring quality practice indicators to ensure ongoing fidelity
• Participate in on-call rotation for remote support within the clinical practice specialist team

Build Capability and Education

• Provide consultancy and support to leadership and frontline staff to promote practice and program excellence in accordance with CarePartners' standards
• Support consistency of complex and chronic care practices across branches
• Collaborate with operations, learning and development, and quality and risk leadership on initiatives such as orientation, role development, and competency development
• Act as a resource to facilitate the full scope of practice for team members
• Contribute to performance appraisal and joint evaluations for nurses regarding complex and chronic care
• Champion the use of digital learning platforms and identify infrastructure needs for 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, integrating adult learning principles
• Assist in developing communication content based on evidence-based clinical and research data, e.g., updates, 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

• Lead and participate in 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 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 experience as 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 of social prescribing and complex/chronic pediatric care (asset)
• Skilled in developing content for best practice pathways and skills training
• Knowledge of change management principles and performance evaluation
• Ability to collaborate with stakeholders, with strong organization, communication, problem-solving, and presentation skills
• Excellent written communication, proofreading, and editing skills
• Ability to multitask, prioritize, and meet deadlines
• Proficiency in Microsoft Office Suite (Word, PowerPoint, Excel)
• Ability to handle sensitive and confidential information
• Willingness and ability to travel within Ontario; valid driver’s license, own vehicle, appropriate insurance

CarePartners In Your Community

CarePartners serves the community through clinics, transitional care units, and relief in retirement homes and shared care settings. Our Community Nursing Services outreach has been organizing staff-led medical care and clinics in underserved countries since 2009.

Accessibility

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