Referrals Coordinator, Social Medicine

University Health Network; Toronto; On-site; CAD 73,000 - 91,000; Full time

Benefits offered by this job

Competitive offer packages

HOOPP pension plan

Transit access

Job summary

University Health Network is seeking a Social Medicine Referrals Coordinator to lead equitable access to Social Medicine services. You will work with patients, families, and interprofessional teams to optimize referral pathways and care transitions across hospital and community settings.

The role emphasizes health equity, trauma-informed care, and collaboration with community organizations to improve outcomes for marginalized populations.

Qualifications

• At minimum, a bachelor’s degree in health sciences, social services, community development, public health, social work, or related field.
• Experience coordinating referrals or patient intake in health, community, or social service settings.
• Experience delivering trauma-informed, anti-oppressive care and equity-focused practices.
• Strong knowledge of community resources addressing social determinants of health.

Responsibilities

• Coordinate referrals and access to health, housing, and community services to ensure equitable service utilization.
• Assess referral appropriateness, identify barriers to care, and develop strategies to facilitate access.
• Provide coaching, guidance, and education to clinical teams and community partners on referral management.
• Develop and monitor referral performance indicators and dashboards for program accountability.
• Promote patient-centered, trauma-informed, and equity-focused approaches to care across teams.
• Participate in quality improvement, program evaluation, and data reporting initiatives.

Skills

Communication skills

Interpersonal skills

Teamwork

Decision-making

Problem-solving

Time management

Education

Bachelor's degree in health sciences or related field

Tools

Epic

Job description

UHN is Canada's #1 hospital and the world’s #1 publicly funded hospital. With 10 sites and more than 44,000 TeamUHN members, UHN consists of Toronto General Hospital, Toronto Western Hospital, Princess Margaret Cancer Centre, Toronto Rehabilitation Institute, The Michener Institute of Education and West Park Healthcare Centre. As Canada's top research hospital, the scope of biomedical research and complexity of cases at UHN have made it a national and international source for discovery, education and patient care. UHN has the largest hospital-based research program in Canada, with major research in neurosciences, cardiology, transplantation, oncology, surgical innovation, infectious diseases, genomic medicine and rehabilitation medicine. UHN is a research hospital affiliated with the University of Toronto.

UHN’s vision is to build A Healthier World and it’s only because of the talented and dedicated people who work here that we are continually bringing that vision closer to reality.

www.uhn.ca

Union: Non-Union

Number of vacancies: 1

New or Replacement: New

Site: Various

Department: Social Medicine & Population Health

Reports to: Senior Manager

Salary Range: $73,000 - $91,347

Hours: 37.5 hours per week

Shifts: Days

Status: Permanent Full-Time

Closing Date: September 9, 2026

Position Summary

The Social Medicine Referrals Coordinator provides clinical-operational leadership in coordinating equitable access to Social Medicine services for patients with complex medical, psychosocial, and health equity needs. As an integral member of the interprofessional team, the Referrals Coordinator is responsible for implementing, coordinating, monitoring, and evaluating referral pathways and care transitions across the health and social care continuum. The role functions as a key liaison between patients, families, healthcare providers, community organizations, and system partners to facilitate timely, integrated, and patient-centred care. The Referrals coordinator exercises independent judgment in assessing referral appropriateness, addressing barriers to access, resolving complex service navigation issues, and facilitating seamless transitions between hospital, community, and social service systems. The Social Medicine Referrals Coordinator provides subject matter expertise, operational leadership, and consultation regarding referral management processes, access optimization, health equity initiatives, community partnerships, quality improvement, and performance measurement. The role contributes to program planning, service development, and system improvement initiatives aimed at advancing access to care and improving outcomes for marginalized and structurally vulnerable populations.

Responsibilities

• Implements and coordinates patient-centered care plan with patients and the multi-disciplinary team for the purpose of facilitating the patient’s movement through the continuum of care and within the community.
• Implements and coordinates patient-centred care plans with patients, families, caregivers, and the interprofessional team to facilitate timely movement through the continuum of care and within community-based services.
• Coordinates complex referrals and access to health, social, housing, and community services, ensuring appropriate and equitable service utilization.
• Assesses referral appropriateness, identifies barriers to care, and develops strategies to facilitate access to required services and supports.
• Acts as a clinical and operational resource regarding referral pathways, eligibility criteria, community resources, and access processes.
• Provides coaching, guidance, consultation, and education to clinical teams, learners, community partners, and referring providers related to referral management and care coordination.
• Facilitates communication among interdisciplinary teams and community organizations to support effective transitions of care.
• Participates in staff onboarding, orientation, and ongoing education related to referral processes, social medicine services, and community resources.
• Identifies and resolves referral-related issues, service access concerns, and care coordination challenges through collaboration and problem-solving.
• Assists with workload prioritization, coordination of referral activities, and service allocation across program streams as required.
• Serves as a resource and role model by promoting patient-centred, trauma-informed, anti-oppressive, and equity-focused approaches to care.
• Develops, implements, and monitors referral performance indicators, including referral volumes, service utilization, turnaround times, access targets, and patient outcomes.
• Collects, analyzes, interprets, and reports referral and operational data to support decision-making, program evaluation, operational planning, and quality improvement initiatives.
• Conducts audits of referral processes, access outcomes, and service utilization to identify trends, gaps, risks, and opportunities for improvement.
• Develops and maintains dashboards, tracking tools, reports, and performance metrics to support program accountability.
• Recommends, implements, and evaluates process improvements that enhance patient access, operational efficiency, and care coordination.
• Monitors referral workflows and operational performance, identifying barriers and escalating issues that may affect patient safety, service quality, or equitable access to care.
• Participates in quality improvement initiatives, program evaluations, and organizational projects designed to improve service delivery and patient outcomes.
• Participates in operational and strategic planning activities supporting the goals and objectives of the Social Medicine Program.
• Develops, strengthens, and maintains collaborative relationships with community agencies, primary care providers, housing organizations, social service agencies, and other system partners.
• Acts as a liaison between Social Medicine services and external referral partners to facilitate integrated care delivery and service coordination.
• Contributes to service planning, forecasting, resource allocation, and referral pathway development to address emerging patient and system needs.
• Supports the design, implementation, and optimization of referral pathways that improve access for marginalized, underserved, and structurally vulnerable populations.
• Represents the Social Medicine Program at internal and external meetings, committees, working groups, and community initiatives, as appropriate.
• Promotes awareness, understanding, and utilization of Social Medicine services among internal and external stakeholders.
• Participates in partnership-building activities and community initiatives that address social determinants of health and support integrated models of care.
• Contributes expertise to organizational initiatives focused on health equity, population health, patient access, and system transformation.
• Provides functional leadership, guidance, and consultation to staff, learners, and community partners regarding referral management processes and best practices.
• Acts as a subject matter expert in system navigation, community resources, social determinants of health, and equitable access to care.
• Participates in program development, policy development, and operational initiatives to advance Social Medicine and Population Health priorities.
• Supports a culture of continuous learning, collaboration, innovation, accountability, and excellence.
• Participates in professional development activities and maintains current knowledge of emerging practices, legislation, and health system priorities relevant to the role.
• Performs cross-functional and organizational responsibilities that support the goals, strategic priorities, and mission of the Social Medicine and Population Health Program and University Health Network.
• Participates in corporate committees, special projects, organizational initiatives, and activities that contribute to program and organizational effectiveness.
• Works in compliance of the Occupational Health & Safety Act and its regulations, reporting hazards, deficiencies and contravention’s of the Act, in a timely manner.
• Works in compliance with the Occupational Health & Safety Act and its regulations, reporting hazards, deficiencies, incidents, and contraventions in a timely manner.
• Promotes a safe work environment and contributes to workplace practices that support employee, patient, and community safety.

• At minimum, a bachelors degree in health sciences, social services, community development, public health, social work, or related field or recognized equivalent required.
• Experience working with patients experiencing marginalization, homelessness, substance use and mental health challenges.
• Experience coordinating referrals or patient intake processes in health, community or social service settings.
• Experience with the provision of trauma-informed care, harm reduction principles, and anti-racist, anti-discriminatory, anti-oppressive practices
• Strong knowledge of, and familiarity with, community resources that address the social determinants of health
• Strong understanding of acute care and community health settings and ability to navigate health systems an asset
• Well-developed decision-making, problem-solving, and judgement skills
• Experience developing community partnerships and collaborative service pathways.
• Excellent interpersonal, oral, and written communication skills
• Experience in program development and implementation
• Experience analyzing operational data and preparing reports.
• Effective time management, prioritization and organizational skills, with the ability to work independently and co-operatively in a busy multidisciplinary environment
• Proven ability to work as a team member and independently
• Ability to have and use diplomacy and tact at all times
• Knowledge of Epic an asset

Why join UHN?

In addition to working alongside some of the most talented and inspiring healthcare professionals in the world, UHN offers a wide range of benefits, programs and perks. It is the comprehensiveness of these offerings that makes it a differentiating factor, allowing you to find value where it matters most to you, now and throughout your career at UHN.

• Competitive offer packages
• Government organization and a member of the Healthcare of Ontario Pension Plan (HOOPP https://hoopp.com/)
• Close access to Transit and UHN shuttle service
• A flexible work environment
• Opportunities for development and promotions within a large organization
• Additional perks (multiple corporate discounts including: travel, restaurants, parking, phone plans, auto insurance discounts, on-site gyms, etc.)

Current UHN employees must have successfully completed their probationary period, have a good employee record along with satisfactory attendance in accordance with UHN's attendance management program, to be eligible for consideration.

All applications must be submitted before the posting close date. UHN uses email to communicate with selected candidates. Please ensure you check your email regularly. At University Health Network (UHN), artificial intelligence technologies may be used to assist in the screening, assessment, and selection of candidates for this position. Please be advised that a Criminal Record Check may be required of the successful candidate. Should it be determined that any information provided by a candidate be misleading, inaccurate or incorrect, UHN reserves the right to discontinue with the consideration of their application. UHN is an equal opportunity employer committed to an inclusive recruitment process and workplace. Requests for accommodation can be made at any stage of the recruitment process. Applicants need to make their requirements known. We thank all applicants for their interest, however, only those selected for further consideration will be contacted.