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
Site: West Park
Department:  5D and 2C - LTV Resp CCC and Neuro Rehab
Reports to:  Clinical Service Manager
Hours: 37.5 Weekly
Shifts: Days
Status: Permanent Full Time
Closing Date: November 12, 2025

Position Summary

This position is responsible for coordinating the care of patients from preadmission to post discharge while meeting length of stay and occupancy rate targets for Long Term Ventilation (LTV), Transition to Home Ventilation (THV) services and Neuro stroke program.

Duties

LTV and Resp CCC

• Collaborate with the Director, Clinical Programs CCC to develop, implement, and monitor the Centre of Excellence (COE) annual work and communication plans.
• Establish and maintain strong relationships with internal and external stakeholders to support COE and LTV/THV objectives.
• Serve as the primary liaison between patients, families, interprofessional teams, and referring agencies, ensuring smooth transitions from referral through discharge.
• Coordinate timely assessments, admissions, and discharges while managing patient flow, waitlists, occupancy, and accountability targets.
• Provide education and ongoing support to referring agencies and families during pre-admission and transition phases, including use of Resource Matching and Referral (RM&R).
• Oversee clinical care coordination, including psycho-social and funding support, and referral to appropriate consultants and disciplines.
• Ensure timely, accurate completion of clinical documentation, including EPR and MDS, and support effective collection and analysis of clinical utilization and COE data.
• Provide clinical leadership to the interprofessional team, supporting person-centred and culturally appropriate care.
• Lead or support program development, evaluation, quality improvement, and research initiatives.
• Participate in relevant internal and external committees and support achievement of clinical service goals in partnership with management.
• Promote a safe environment by identifying risks, adhering to hospital safety standards and legislation, and attending safety training.
• Demonstrated ability to deal with complex mental health and behavioral issues
• Demonstrate and promote West Park’s core values: Excellence, Respect, Trust, Collaboration, and Accountability.
• Ensure timely and accurate completion of clinical documentation, NRS and MDS.
  
  Neuro Stroke
   
• Manage wait-list, occupancy rates and patient flow for the service considering alternate levels of care.
• Liaise with referring agencies and provide ongoing support/education during the pre-admission phase using Resource Matching and Referral (RM&R).
• Co-ordinate the care of clients from pre-admission to post-discharge, regularly assessing needs such as psycho-social support for the patient and family as well as funding support while meeting length of stay and occupancy rate targets.
• Ensure timely and appropriate clinical documentation in the electronic patient record (EPR).
• Develop strong relationships community providers to facilitate   partnerships between patients, family, inpatient clinical team and referring agencies.
• Refer and coordinate consultant / discipline involvement as needed.
• Support collection of clinical utilization data in collaboration with Program Service Manager.
• Provide resource clinical leadership for the interprofessional team.
• Provide leadership in program evaluation, program development and research as appropriate.
• Participate in internal and external committees.
• Partner with Program Service Manager to ensure clinical service goals are addressed.
• Ensure that clinical care issues / concerns are addressed in a timely and effective manner.
• Ensure that care is patient-focused with an emphasis on culturally appropriate care.
• Perform other duties as assigned..

• Bachelor of Science in respective Health Discipline
• BCLS
• Regulated Health Discipline
• Registered in good standing with respective Regulated Health Discipline College of Ontario
• Minimum of 4 years clinical experience in a healthcare environment
• Demonstrated exceptional clinical assessment skills including the ability to assess clients from pre-admission to post discharge
• Must be able to achieve 80% in the Functional Independent Measure (FIM) certification exam within the probationary period and on recertification exams if applying to work on rehabilitation units
• Knowledge of external agencies and resources
• Demonstrated ability to partner and work effectively with staff, the interprofessional team, physicians, patients, families and external agencies
• Demonstrated ability to address complex clinical issues within the context of social determinants of health
• Ability to maintain effectiveness in varying environments and with different tasks, responsibilities and people
• Demonstrated knowledge of and ability to provide person centered care.
• Demonstrated organizational, problem solving, interpersonal, coaching, negotiation and facilitation skills
• Strong organizational skills to work independently in an unstructured, demanding environment
• Demonstrated reliable work habits
• Ability to work a flexible schedule
• Strong Windows based computer skills e.g. Microsoft Office Suite
• Evidence of good performance history and attendance record

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 compensation & benefits (medical, dental, etc.)
• HOOPP defined benefit pension plan
• Wellness services & offerings
• Close access to the TTC and UHN shuttle service
• 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.)

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.

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.