We are currently recruiting for a Registered Nurse (Chronic Disease Management)
Employment: Full-time, permanent
Schedule: Days (Some evenings and weekends required)
Hire Date: Fall 2026
Location: Multi-site: This position will be required to work at both locations, our new clinic space based in East Mississauga and CarePoint Health’s main clinic location at CarePoint Health – 2695 North Sheridan Way, Suite 120, Mississauga, ON
Salary: $67,320.13-$79,200 per year and a comprehensive benefits package (including HOOPP)
Who we are?
CarePoint Health (CPH) is a primary care hub consisting of a team of affiliated physicians and allied health professionals aiming to improve the health and wellness of the Mississauga communities.
CPH’s mission is to improve health outcomes for our community through partnerships in a culture of innovation. Our goals are to are to increase patient satisfaction, improve provider work life, improve population health, and reduce health care costs.
At CPH we support patients by connecting them to a coordinated, comprehensive team of health care professionals upon whom they can rely on and work with to achieve their personal health goals. The interprofessional team collaboratively delivers holistic care by addressing patients’ physical health, mental health and social determinants of health.
What is this role?
The Registered Nurse - Chronic Disease Management (CDM-RN) is a proven team player that works collaboratively with the interdisciplinary staff members and affiliated family physicians to manage the needs of patients with chronic disease management across their journey at CarePoint Health. The CDM-RN is responsible for the assessment, planning, coordination, and delivery of services, consistent with the principles of primary health care and the requirements of the CDM program at CPH. Functioning in a case management role, the CDM Nurse uses critical thinking and clinical judgment in coordinating and facilitating the management of chronic illness. She/he requires strong interpersonal communication and interdisciplinary team player skills. This includes following established care pathways for patient care, making internal connections as needed, and linking patients with appropriate regional and community programs.
Responsibilities:
Reporting to the Clinical Manager your key responsibilities would include:
- Performing initial and ongoing bio-psychosocial assessment specific to CDM and target population, which may include, but is not limited to the following areas:
- Physical status
- Psychological status
- Social/family interactions
- Spiritual status
- Financial status
- Learning capabilities and education needs
- Self-management capabilities
- Health risks
- Cultural influences
- Social determinants of health
- Screen referrals for eligibility and suitability for admission into a CDM program
- Use algorithms, and establish a plan of care based on assessment needs
- Analyzes assessment data to identify the individual/family needs and strengths
- In collaboration with the individual/family and family physicians develops the plan of care including consideration of strengths, risk factors, options, consequences of actions, health promotion, learning, comfort, safety, privacy, dignity and integrity
- Applies knowledge of pertinent profession-specific and related healthcare research and evidence to care planning, uses current knowledge to justify the plan of care
- Integrates multidisciplinary team and community resources into the care plan
- Demonstrates knowledge of the CDPM Framework and objectives of CDM, case management in a primary interdisciplinary setting
- Provides patient education to increase patient’s knowledge of their condition and promote self-management
- Evaluates expected and unexpected responses to care, in partnership with individuals and interdisciplinary team member
- Participates in and supports the development and implementation of the plans, goals and objectives of the workplace
- Collaborates with the team and the affiliated physician as the care coordinator
- Promotes a positive work environment
- Reporting and recording accurately and appropriately, using electronic charting
- Other duties as assigned including primary care nursing responsibilities as required (including home visits)
Qualifications:
The right individual would have:
- Holds a current certificate of registration in good standing with the College of Nurses of Ontario
- Graduate of a Bachelor of Science in Nursing (BScN) from an accredited program
- Possesses a current BCLS certification for health care providers
- Previous CDM (cardiac risk reduction, diabetes education, weight management, COPD/Asthma and community care experience required of at least 2 years required working with adults in a
- Experience providing care navigation and coordination
- Be bilingual as an asset
- Demonstrated achievement of good working relationships with interprofessional team members
- Excellent physical assessment skills
- Previous experience with an electronic medical record (EMR) program
- Demonstrated excellent critical thinking, decision making and problem-solving skills
- Excellent interpersonal and communication skills
- Demonstrate satisfactory work performance and attendance history
- valid driver’s license and reliable vehicle
- Flexibility to work evenings and weekends as required
- A satisfactory and current Criminal Background and Vulnerable Sector Screening and proof of immunization required
- Vaccines (COVID-19 and others) are a requirement of the job unless you have an exemption on a medical ground pursuant to the Ontario Human Rights Code
Why CarePoint Health?
· Excellent benefits package and pension plan (HOOPP)
· Professional development days and allowance to support ongoing learning.
· Innovative, collaborative, and supportive team environment
· Work culture that promotes work-life balance and life-long learning
· A community of mental health professionals (psychologists and psychatrists) and other allied health professionals on site
· Opportunities for collaboration and leadership and innovative projects
· Located in Mississauga just off the QEW at Winston Churchill and a 30-minute drive to Toronto.
At CPH we are developing and implementing a new model of primary care for the future. Being part of CPH means that you will have the opportunity to contribute to building a patient centered, partnership based and innovative model of care.
Are you ready to join an extraordinary team and do the best work of your life?
CarePoint Health offers employees an excellent benefits package and pension plan (HOOPP). Compensation for the role will be aligned with candidate’s skills and experience and within the budget of CPH.
Application:
Interested candidates are invited to submit a cover letter and resume via Indeed.
Please note, only those candidates selected for an interview will be contacted.
CPH is a respectful, caring and inclusive workplace, committed to Employment Equity. We welcome diversity in the workplace, and encourage applications from all qualified individuals including women, members of visible minorities, aboriginal persons, and persons with disabilities. We will provide accommodations throughout the recruitment and selection and/or assessment process to applicants with disabilities. Applicants need to make their accommodation needs known when contacted.
Job Type: Full-time
Pay: $67,320.13-$79,200.00 per year
Benefits:
- Dental care
- Extended health care
- Life insurance
- On-site parking
- Paid time off
- Vision care
Ability to commute/relocate:
- Mississauga, ON L5K 2N6: reliably commute or plan to relocate before starting work (preferred)
Education:
- Bachelor's Degree (preferred)
Work Location: In person
