Transition Services Coordinator (Allied Health)

Description

JOB SUMMARY:Within the context of a client and family centered care model and in accordance with established vision and values of the organization, the Transition Services Coordinator (Allied Health) leads and facilitates acute to community transitions by collaborating with the care team, assessing and evaluating clinical and functional need and coordinating community staff/resources in carrying out the care following discharge from an acute site. Provides input to the Manager, Clinical Operations Supervisor and/or Clinical Nurse Educator on the development and recommendation of changes to related Transition Services policies, procedures or protocols for care transition from acute to community. Coaches and encourages acute and community colleagues to embrace new and evolving clinical pathways. Plans and facilitates clinical discussions to support safe client discharges with care teams and other health care professionals; advises on the availability and eligibility for community services. Makes community referrals based on client needs, urgency and the recommendation of the care team; educates and provides consultation to client/family about the community services and options available to them upon discharge and the transition plan. Assesses and coordinates transition of clients to long term care (LTC), utilizing clinical decision support tools (Inter-RAI MDS) as appropriate. Documents and maintains client records and clinical assessments. Participates on committees as directed. Coordinates care given by others in an area or unit by assigning service priority to various Home Health teams and making/adjusting client/patient/resident assignments.QUALIFICATIONS:Education & Experience Master’s degree in a Health Science discipline with three (3) years’ experience in an acute and/or community health setting including one (1) year experience in complex discharge planning or an equivalent combination of education, training and experience. Eligible for registration with the appropriate professional body or association, as applicable. Knowledge & AbilitiesBroad knowledge of applicable allied practice and practice within a client and family centred model of care.Broad knowledge of evidence based practice related to patient acuity and bed utilization practices within an acute care setting.Broad knowledge of other health care disciplines and their role in client care and discharge planning.Broad knowledge of home and community care.Demonstrated knowledge of hospital discharge processes, including Alternate Level of Care.Broad knowledge of clinical studies methodology and data presentation.Demonstrated ability to apply acquired analytical/investigative skills and the knowledge to effectively gather, maintain and analyze statistics.Demonstrated ability to apply critical thinking within clinical and evaluation activities.Demonstrated ability to work independently.Demonstrated ability to work collaboratively as a member of an interdisciplinary team.Demonstrated ability to provide leadership, work direction and consultationDemonstrated ability to demonstrate, facilitate and coach.Demonstrated ability to communicate orally and in writing.Demonstrated ability to communicate with, and deal effectively with, co-workers, physicians, other health care staff, clients and their families, and staff of outside agencies.Demonstrated ability to effectively deal with conflict situations.Demonstrated ability to adjust to new or unexpected events.Demonstrated ability to plan, organize and prioritize work.Demonstrated physical ability to perform the duties of the position.Demonstrated computerized software skills in word processing, databases, spreadsheets, presentations and internet access and ability to operate a computerized patient care information system.Ability to operate related equipment.The hours of work including days off and work area may be subject to change consistent with operational requirements and the provision of the Collective Agreement and applicable statutes.

Details

At Vancouver Coastal Health, our vision of healthy lives in healthy communities inspires us and our values and pillars guide us. We support equitable practices, diverse teams and inclusive environments, which are vital to creating welcoming spaces where everyone can bring their whole selves to work and feel supported. We encourage applications from equity-deserving communities, including Indigenous Peoples and members of racialized groups, people with disabilities and people of all gender identities and expressions and sexual orientation.Vancouver Coastal Health is proud to be recognized as one of BC’s Top Employers, Canada’s Best Diversity Employers and Canada's Top Employers for Young People in 2025.Unless otherwise noted on the posting, internal job postings close at 8:00 AM Pacific Time on the listed Closing Date. Please submit your digital application via the Internal Career Portal prior to the Closing Date & Time.Nursing & LPN successful applicants will be notified by email.We regret that only short listed candidates will be acknowledged.This is an internal job posting for Vancouver Coastal Health employees only.