Manager, Hospital to Home and Clinical Programs

Job Description

The Manager, Hospital to Home and Clinical Programs is accountable for leading a dedicated service team in delivering seamless and timely care that meets the unique needs of clients transitioning from hospital to home, as well as those receiving community-based services. The Manager ensures the team effectively plans, organizes, implements, and delivers high-quality, responsive, and integrated care.

The Manager supports the success of the transitional care program, while also ensuring continuity and excellence across broader clinical services. The Manager develops and retains a high-performing team of front-line staff, providing strong leadership and operational oversight. This includes driving the adoption of effective systems and business processes, supporting clinical accountability, and fostering a collaborative and positive workplace culture.

We are looking for: A Full-Time Permanent Manager, Hospital to Home and Clinical Programs

Hours of Work: Monday – Thursday: 8:30AM to 4:30PM, Friday: 8:30AM to 3:30PM. This is a hybrid work from home role. On-Call is required.

Reports to: Director, Client Services

Compensation

Hiring Salary Range: The salary for this role ranges from $80,000 to $110,000 per year, depending on your skills and experience.

Circle of Care Benefits:

Hybrid Environment: This is a hybrid position, with a mix of 3 in-office work and 2 work-from-home days, offering a balanced hybrid schedule. Our main office at 4211 Yonge Street has subsidized underground parking and is located conveniently on the subway line and GO transit.

Health and Dental Benefits: A robust benefits plan with comprehensive health, dental, paramedical and vision coverage with employer paid premiums to support you and your family through all stages of life.

Retirement Savings Plan: As part of our commitment to your long-term well-being, we provide an RRSP program through RBC with employer and voluntary employee contributions.

Learning and Development: We support your continued growth and learning through paid training and professional development opportunities throughout your career.

Responsibilities

Excellence and Quality Improvement

• Manage relationship building and rapport with external partners.
• Provide professional leadership to the service team members and ensure employees are fulfilling their mandate and accountabilities.
• Ensure that clients and their families experience high-quality, responsive healthcare service and goal-based outcome.
• Implement quality assurance and improvement programs, processes, and accountability for the team.
• Work closely with the Quality team to ensure timely and accurate data collection, reporting to Sinai Health, as part of ongoing program evaluation and improvement.
• Conduct documentation audits to ensure compliance with clinical and reporting standards.
• Support the development and implementation of professional practice guidelines and standards across client services.
• Monitor program indicators, including time to first service, missed care, client experience, and length of stay use where data is available.
• Translate audit findings, client feedback, and performance trends into improvement plans with assigned responsibilities and timelines.
• Report program performance, emerging risks, and corrective actions to the Director and relevant partners.

Leadership & Change Management

• Actively develop and foster trust-based, collaborative partnerships with external key organizations, including OHAH, funders, and hospitals.
• Lead weekly huddles with the Sinai Health team to provide updates on active H2H clients and discuss care plans and barriers.
• Participate in case conferences with patients and families where necessary to ensure transparent care coordination.
• Support smooth patient discharges and transitions to Ontario Health at Home, self-care, or long-term care.
• Identify opportunities to demonstrate Circle of Care’s service assets and commitment to excellence to key partners and funders.
• Lead and resolve client or family escalations, participating in challenging conversations to support service recovery and continuous improvement.
• Lead recruitment, onboarding, performance reviews, and staff development with HR
• Set clear performance expectations and address practice or performance concerns through coaching and follow-up.
• Develop succession plans and strengthen team capability
• Complete regular risk assessments to identify operational risks, service gaps, and anticipated increases in staffing requirements.
• Collaborate with Finance to review program demands, assess financial implications, and develop proposals to support additional staffing and resource needs.
• Facilitate regular huddles with Rehabilitation, Nursing, and Social Work teams to ensure client goals are being met and appropriate transition supports are in place.
• Provide oversight and guidance to the Program Supervisor regarding caseload assignments, workload distribution, and resource utilization.
• Ensure all partners supporting the program adhere to established program guidelines, eligibility criteria, service expectations, and operational standards.
• Monitor program performance, client outcomes, service utilization, and staffing capacity to identify opportunities for improvement.
• Maintain ongoing discussions with leadership and key stakeholders regarding program needs, service pressures, and opportunities for expansion.
• Participate in strategic planning to support program growth, sustainability, and enhanced service delivery.
• Participate in relevant conferences, meetings, and presentations to share program outcomes, best practices, and lessons learned.
• Identify opportunities for continuous quality improvement and strengthen collaboration among hospital, community, and care transition partners.

Management of Relationships with Internal Partners

• Model the way for employees through personal example and a dedication to action, results, and client service excellence.
• Develop and sustain a team culture that embodies open, two-way communication, client-centered focus, learning and innovation, accountability, teamwork, and continuous improvement.
• Provide consistent coaching, communication, and support to front-line staff, ensuring clarity on clinical practice and program expectations.
• Hold regular team meetings and training sessions to ensure ongoing staff education aligned with program needs and best practices.
• Lead CRM development and improvement work to ensure the system meets program needs, supports daily workflows, and enables accurate documentation and reporting.
• Actively participate in program design and development discussions, contributing operational insights and innovations.
• Engage in conversations and planning related to resource optimization, including changes to staffing models to ensure the right care is delivered by the right team members at the right time.

Operational and Financial Management

• Oversee referral intake, eligibility review, service initiation, and discharge planning.
• Monitor client volumes, acuity, staffing capacity, and workload, adjusting resources as needed.
• Manage program budgets within approved allocations.
• Establish coverage and escalation plans for staffing shortages, service disruptions, and urgent client needs, including after hours.
• Ensure services meet contractual commitments and funder requirements.
• Provide hands-on support to the supervisor and team when volumes increase, or coverage is limited, taking an all-hands-on-deck approach.

Risk, Health and Safety Management

• Identifying and reporting health and safety incidents and concerns in a timely manner to the appropriate supervisors and/or funders, documenting incidents in EasyCare and escalating appropriately to the designated supervisors as outlined in the Client Safety Reporting policy (C.01.38).
• Participating in health and safety processes and procedures
• Participating in maintaining a safe workplace environment by cultivating a positive safety culture and encouraging best practices to promote both staff and client safety and well-being
• Participating in all health and safety training initiatives on a regular basis.
• Taking proactive action against client incidents within your scope of practice.
• Developing a plan to identify, manage and/or minimize client safety risks or situations in adherence with risk management operations policies.
• Assessing the severity of an adverse client safety/risk event and determining the best follow-up and developing an action plan following the event. Collaborating with funder (ex. HCCSS) and following any additional processes as required.
• Calling emergency services (911) when the client is at an immediate risk of harming themselves or others, or if there is a serious injury and/or imminent harm.
• Evaluating any potential hazards and identifying clients at risk for adverse health and safety events, taking preventative measures when necessary to minimize reoccurrence.
• Reporting all safety events impacting clients, caregivers and families in a timely and honest disclosure.

Qualifications

• Current registration in good standing with the College of Nurses of Ontario (CNO) as a Registered Nurse (RN) or Registered Practical Nurse (RPN).
• Demonstrated nursing experience in a community-based setting, such as home care, community health, or transitional care.
• Understanding of leadership, change management, business systems, and processes.
• Knowledge of community resources, health care, and social service systems.
• Advanced skills in an automated environment, Microsoft Office; Excel and Power Point.
• Ability to travel to various worksites on a regular basis and to respond to emergency situations.
• Ability to maintain confidentiality and work independently while collaborating with a multidisciplinary team.

Additional information

Circle of Care is committed to fostering an inclusive, accessible environment, where all employees, volunteers and clients feel valued, respected and supported. We are dedicated to building a workforce that reflects the diversity of the communities in which we live and serve, and creating an environment where every employee has the opportunity to reach their potential. Circle of Care seeks applicants who embrace our values of equity, anti-racism, and inclusion. As such, we encourage applications from candidates who have been historically disadvantaged and marginalized, including but not limited to those who identify as First Nations, Métis and/or Inuit/Inuk, Black, members of racialized communities, persons with disabilities, women and/or 2SLGBTQ+.

We are committed to an environment that is barrier free. If you require accommodation, please inform us in advance.

We thank you for your interest in Circle of Care. We welcome you to apply for this role, even if you do not meet every requirement listed. Circle of Care may use artificial intelligence (AI) through third-party platforms, to assist in parts of the recruitment and/or selection process. Only applicants who are selected for an interview will be contacted.

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