Care Coordinator - Nurse

Serefin Health is a leading healthcare organization dedicated to improving client outcomes and providing exceptional care coordination. Our nursing team supports diverse programs and populations, including care coordination across the lifespan, travel support, employee wellness clients, and other Serefin programs as they evolve. We are currently seeking motivated and experienced nurses to join our Care Coordination nursing team. If you are a dependable and compassionate nurse with a commitment to delivering high quality care and possess excellent communication skills, we invite you to be a part of our innovative health team.

Role Profile

As a Care Coordinator - Nurse (Remote) at Serefin Health, you will play a crucial role in supporting clients across various care programs, locations and client populations. Reporting to the Manager, Virtual Nursing Team, the Care Coordinator – Nurse provides dependable, compassionate, client-centred virtual nursing support to clients and families. You will help clients understand their needs, navigate resources, follow through on care plans, and feel supported throughout their healthcare journey.

Key Responsibilities

• Complete intakes and nursing assessments to understand client needs, health history, social supports, caregiver needs, goals and appropriate program/resource pathways.
• Develop, document and update care coordination plans with clients and caregivers, including priorities, realistic goals, follow-up actions and clear next steps.
• Support clients, caregivers and families through empathetic education, coaching and motivational interviewing so they understand provider instructions, symptoms, care plans, treatments, records and
  self-management needs.
• Navigate healthcare, community, social, benefits, workplace, wellness, travel and virtual resources; support appointment preparation, referrals and follow-up; identify gaps; and advocate respectfully for access, continuity and client preferences.
• Coordinate and share relevant information with authorized providers, care team members, program partners and internal colleagues in a timely, privacy-compliant manner to support transitions, reduce duplication and improve continuity of care.
• Provide non-emergency guidance, check-ins and monitoring; recognize changes, symptom concerns, mental wellbeing or caregiver concerns; and escalate for clinical review, provider follow-up or emergency care as appropriate.
• Use Serefin digital platforms, documentation tools and communication pathways securely to consolidate health information, manage caseload priorities, maintain confidentiality and support high-quality care.
• Collaborate with colleagues and leaders to strengthen care coordination resources, referral/resource libraries, workflows, digital tools, platforms and communication pathways; participate in meetings, training and quality improvement.
• Work independently with sound judgement while remaining responsive, team-oriented and aligned with clinical standards, policies and operational needs.
• Support the organization's operational priorities and contribute to other business initiatives as required.

Skills, Knowledge and Expertise

• Registered Nurse (RN), Registered Practical Nurse (RPN), or Licensed Practical Nurse (LPN) currently registered and in good standing with their respective college.
• Minimum 3 years of nursing experience in acute care (e.g., Emergency, Medicine, ICU), community care, primary care, complex care, or a related setting.
• Experience in nursing with the elderly population and individuals with complex needs is desirable.
• Strong assessment, triage, documentation, teaching, and coaching skills.
• Ability to support clients, caregivers and families through complex, sensitive or emotional conversations with empathy, professionalism, cultural humility and clear boundaries.
• Demonstrated problem-solving, decision-making, and critical thinking skills while effectively managing multiple priorities.
• Works well both collaboratively and independently.
• Excellent interpersonal and communication skills, both oral and written.
• Proficiency in English is required. French fluency is strongly preferred; additional languages are an asset.
• We are dedicated to fostering a culturally safe, inclusive, and equitable workplace. We strongly encourage applications from Indigenous peoples (First Nations, Inuit, and Métis), and we value Indigenous knowledge, lived experience, and community connection. Voluntary self-identification is welcomed and respected.
• Comfortable using technology, including electronic documentation platforms, Microsoft 365 applications, telephone systems, and other digital tools.
• Must have a private, secure workspace with a door that can be closed to maintain client privacy and confidentiality.
• Up-to-date Police Reference Check.
• The role requires the ability to work regularly on evenings, nights, weekends and statutory holidays.

If you are a compassionate and dedicated nurse who is ready to take on the challenge of shaping the future of healthcare, we encourage you to apply for this Care Coordinator - Nurse position at Serefin. Join our team and make a meaningful impact on the lives of our clients as we work together to provide the best possible care and support.

Originally posted on Himalayas