Transition Services Complex Coordinator

Alberta Health Services; Edmonton; On-site; CAD 30,000 - 60,000; Full time

Job summary

Alberta Health Services seeks a Transition Coordinator - Complex to provide holistic assessments and care coordination. This crucial role focuses on patient needs across acute and community settings and requires strong clinical decision-making skills. Candidates must have RN status and experience in healthcare settings, supporting vital nursing services and ensuring quality care delivery.

Qualifications

• Minimum of five years experience as Transition Coordinator in acute/community settings.
• Ability to assess clients in person and articulate assessment details.
• Capable of managing high stress and fluctuating priorities.

Responsibilities

• Conduct comprehensive assessments and care planning for clients.
• Coordinate service delivery across various healthcare programs.
• Communicate effectively with clients, families, and healthcare professionals.

Skills

Critical thinking

Problem solving

Clear communication

Education

Completion of an accredited nursing education program

Active registration with College of Registered Nurses of Alberta

Current Basic Cardiac Life Support certification

Tools

Microsoft Applications

interRAI Tools

Connect Care

e-People

Job description

Your Opportunity:

AHS is dedicated to Enhancing Care in the Community, helping people be healthy, well & independent in their homes and communities. Edmonton Zone Continuing Care provides services through five main program areas: Home Living, Supportive Living, Facility Living, Transition Services & Palliative Care. The Transition Coordinator - Complex (TC-Complex) is a clinical consult-based position. TCs assess patients’ needs in the context of the whole person including their life situation & determinants of health. Critical thinking & accurate interpretation of complex information from a variety of sources are essential to the clinical decision-making required for the determination of appropriate continuing care living options.

The role of the TC is highly complex and includes comprehensive assessment, planning and coordination of care, as well as ongoing communication with other health-care providers across the continuum of care. Major responsibilities include completing a summary based on the Most Responsible TC’s comprehensive electronic needs assessments, determining urgency/ priority, developing & implementing appropriate service plans, coordinating service delivery across programs/settings, liaising with Continuing Care staff & other community resources, providing information & support to clients, families, & caregivers. The TC works within a multi-disciplinary team of health professionals & is responsible for appropriate referral to other programs/services, documentation, guidance in complex case review conferences & team meetings, complex review & recommendation process, & outcome evaluation & professional development activities. This position requires seeing complex clients in person within acute & community settings across the Edmonton Zone.

Description:

As a Registered Nurse (RN), you will provide a wide variety of nursing services to patients, families, communities and populations, ensuring their safety and well-being. You will utilize nursing processes, through critical thinking, problem solving and decision making, as well as teach, counsel and advocate on behalf of patients and their families. You will support an integrated and holistic approach to patient care, health promotion and maintenance, providing safe, quality patient and family-centered care aligned with AHS values.

PLEASE NOTE: Provisional Permit Holders shall be paid $39.58 /hour - $54.16/hour. Upon registration as a Registered Nurse, pay will be adjusted according to AHS/UNA agreements.

• Classification: Registered Nurse
• Union: United Nurses of Alberta
• Unit and Program: Transition Services
• Primary Location: Bonaventure Gates
• Location Details: As Per Location
• FTE: 0.00
• Posting End Date: 07-JUL-2025
• Employee Class: Casual/Relief
• Date Available: 17-JUL-2025
• Hours per Shift: Varies
• Shift Pattern: Days, Evenings, Weekends
• Days Off: Other
• Minimum Salary: $43.26
• Maximum Salary: $59.21
• Vehicle Requirement: Driver's License, Vehicle Required

Required Qualifications:

Completion of an accredited nursing education program. Active or eligible for registration and practice permit with the College of Registered Nurses of Alberta (CRNA). Current Basic Cardiac Life Support - Health Care Provider (BCLS-HCP). If not practiced as a RN within the last five years, completion of CRNA Medication Management - Chapters 1-4 and NextGenU Health Assessment Resources Certification is required.

Additional Required Qualifications:

Minimum of five years Transition Coordinator experience in acute and community settings, including home care, supportive living or facility living. Ability to lead and participate in multiprofessional rounds, work independently and in teams, manage time effectively, resolve conflicts, and communicate clearly. Ability to assess clients in person across various environments, review and articulate assessment details, and provide feedback verbally and in writing. Capable of handling high stress, fluctuating priorities, and deadlines. Tolerant of long periods of sitting or standing and repetitive movements.

Preferred Qualifications:

Knowledge of Microsoft Applications, Pathways, interRAI Tools, Connect Care, and e-People is an asset.