Jobs in Richmond Hill

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Within 25 km of Richmond Hill

Added 17 hours ago
FE
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Clinical Care Facilitator
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Toronto, ON
Added 20 hours ago
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Michael Garron Hospital

Clinical Care Facilitator

Toronto, ON, Canada

Full-time

Within 25 km of Richmond Hill · About 20.3 km from the city centre

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Job details

Job type: Full-time
Apply by: Dec 4, 2026
Posted: Nov 4, 2026

Original job description

Company Description Michael Garron Hospital (MGH) is a community teaching hospital in East Toronto, serving more than 400,000 people across 22 diverse neighborhoods. For over 90 years, MGH has provided high-quality, patient-centered care along the full continuum of health needs, from birth to end-of-life. As a full-service hospital, MGH collaborates with strong community and research partners and is a proud member of East Toronto Health Partners, the Ontario Health Team serving East Toronto. MGH has been recognized as one of Greater Toronto’s Top Employers for multiple consecutive years, reflecting its focus on workplace best practices and staff well-being. The hospital promotes a respectful, kind, and considerate environment, including on its social media platforms, where clear community guidelines support safe and inclusive engagement.

Role Description

East Toronto Care Network (EastTCaN), based at Michael Garron Hospital, is seeking a Physician Assistant (PA) to join our innovative Integrated Care Pathways team as a Clinical Care Facilitator (CCF).

The CCF plays a key clinical role in supporting patients with complex health needs, particularly those living with Chronic Obstructive Pulmonary Disease (COPD), Congestive Heart Failure (CHF), and Community-Acquired Pneumonia (CAP).

Working collaboratively with physicians, specialists, primary care providers, and interdisciplinary teams, the CCF provides direct patient care, supports chronic disease management, facilitates safe transitions from hospital to home, and helps prevent avoidable emergency department visits and hospital readmissions.

Key responsibilities include:

Conducting patient assessments, clinical follow-ups, and ongoing monitoring.
Supporting chronic disease management, medication optimization, and individualized care planning.
Coordinating care transitions between hospital, primary care, and community services.
Providing patient and caregiver education to support self-management.
Collaborating with interdisciplinary teams to address complex medical and social needs.
Contributing to the ongoing development, evaluation, and quality improvement of integrated care pathways.
This is an opportunity to be part of a collaborative, evolving program focused on transforming how patients experience care across the healthcare system.

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More about this job

Responsibilities

Conduct patient assessments, follow-ups, and ongoing monitoring, while supporting chronic disease management, medication optimization, and individualized care planning. Coordinate transitions between hospital, primary care, and community services; educate patients and caregivers; collaborate with interdisciplinary teams; and contribute to integrated care pathway development and quality improvement.

Requirements

The role is for a Physician Assistant to serve as a Clinical Care Facilitator on the Integrated Care Pathways team. The posting emphasizes clinical care for patients with complex needs, particularly COPD, CHF, and community-acquired pneumonia, but does not specify formal education or years-of-experience requirements.

Skills

Patient Assessment
Clinical Follow-Up
Patient Monitoring
Chronic Disease Management
Medication Optimization
Individualized Care Planning
Care Coordination
Care Transitions
Patient Education
Caregiver Education
Interdisciplinary Collaboration
Self-Management Support
Quality Improvement

Visa sponsorship

Not detected in the job text

Keywords

Physician Assistant
Clinical Care Facilitator
Integrated Care Pathways
Chronic Obstructive Pulmonary Disease
Congestive Heart Failure
Community-Acquired Pneumonia
Patient Assessment
Clinical Follow-Up
Chronic Disease Management
Medication Optimization
Individualized Care Planning
Care Coordination
Hospital-to-Home Transitions
Primary Care
Community Services
Patient Education
Caregiver Education
Self-Management
Interdisciplinary Teams
Complex Medical Needs
Social Needs
Hospital Readmission Prevention
Quality Improvement

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