Nurse Navigator – Chronic Disease & Elder Care Programs

Bayshore Health Care is one of the Canada’s leading providers of home and community health care services and is a privately owned company. Bayshore Health Care is proud to showcase its achievement as a Platinum member of Canada’s Best Managed Companies Program every year since 2006. Bayshore Healthcare is also recognized as Canada’s Best Employers in Forbes 2023 list. Carepath Digital Health is a Canadian virtual healthcare navigation service owned by Bayshore Health Care that helps individuals and families manage complex medical conditions, cancer diagnoses, chronic illnesses, and mental health needs.
Care Path Digital Health is seeking a highly skilled and compassionate Nurse Navigator (Registered Nurse) to join our esteemed team.

Job Summary:

A Nurse Navigator at Carepath practices within the standards and scope of practice established by the nursing regulatory body in their province of practice. They play a vital role in supporting clients living with chronic disease and elderly-related needs, aiming to enhance health outcomes and quality of life. This includes assisting clients seeking a second opinion through our partnership with the Cleveland Clinic and providing health coaching, education and navigation, using evidence-based strategies to help clients better manage their unique needs.

The Nurse Navigator promotes clients' health and quality of life through education, support, empowerment, and advocacy. The Nurse Navigator collaborates with clients, families, and the Carepath team to enhance care.
Duties and Responsibilities   Assess the client’s specific program needs.
Facilitate access to the provider of second opinion consults:  Collect necessary information (condition-specific questionnaires) and consent.
Support the collection of medical records required for the second opinion.
Arrange for and participate in the post-second-opinion conference with the client and their families to discuss the results.
Provide an explanation of the recommended treatment plan options as required.
Navigate the implementation of the recommendations of the conference.
Assist with any follow-up questions back to the second opinion provider.
Assist with setting up any treatment options.

Utilize standard tools to assess the client’s need for health coaching, considering the individual's knowledge of the condition, stability of the condition and/or motivation to self-manage their condition.
Provide health coaching using motivational interviewing techniques to assist clients with goal setting based on strategies developed for the individual’s readiness to learn.
Assess client’s health coaching outcomes using standardized tools.
Guide the client to alternate treatment location(s) if requested.
Document all client-related activities (tasks, phone calls and emails) in the client's electronic database.
Ensure client records are maintained, and data are accurate to meet program reporting requirements.
Participate in program quality activities and continuous improvement initiatives in keeping with the company’s Quality Management System and ensure best practice is reflected.
Maintain skills and competencies by participating in ongoing internal and/or external continuing education activities.
Adhere to all program and organizational Policies and Procedures.
Participate in proactive Health and Safety activities while performing all duties. Is responsible for notifying the immediate Supervisor of any Health and Safety risks or concerns.
Maintains confidentiality of client and corporate information and discusses the same with appropriate Carepath and/or Bayshore personnel.
Completes other tasks as requested.
Reporting Relationship  The Nurse Navigator reports directly to the Lead Nurse Practitioner / Program Director, Chronic…