Systems Navigator

internal/external posting

job title: Systems Navigator

job ID #: LGB SN 21-1123

department: LGBT2SQ Communities

reports to: Programs & Services Director, LGBT2SQ Communities

salary range: CS4 – $31.33 – $38.87 per hour

status: Full Time, Permanent

hours: 37.5 hours

Who we are:

Sherbourne is a leading provider of quality health care and transformative support to people who face social, economic and other systemic barriers.   Our mission is to advance the equity and quality of care and services and to improve health for underserved communities.  This is done through primary health and chronic disease services; health promotion and education; outreach and social supports; and mental health services.

Sherbourne provides innovative health care and social services to the diverse urban population of southeast Toronto.  While our doors are open to everyone, we focus on people who are homeless or under-housed; LGBTQ, and newcomers to Canada.  We are funded by the Ministry of Health, Toronto Central LHIN, Ministry of Child and Youth Services, City of Toronto and many generous companies, groups and individuals.

Working at Sherbourne

At Sherbourne Health, we care about our staff and recognize that our biggest strength is our people. We have a solid commitment to life-long learning which is demonstrated through our professional development program. We invest in collective work and staff training to improve client care. We supplement this by creating a low-barrier work environment built on equity and respect, while working together in caring, cohesive teams and providing opportunities for advancement.

we believe in work-life balance and offer:

  • Four weeks of vacation per year (to start).
  • A competitive salary.
  • Membership in Healthcare of Ontario Pension Plan (HOOPP).
  • An extended healthcare and dental package.
  • Long-term disability insurance.
  • Life insurance.
  • Four personal days per year.
  • An employee assistance plan.
  • A generous professional development plan: up to $1300 to be used towards learning activities.
  • Six fully paid professional development days per year – related to position/responsibilities.


about the role:

Working with gender-diverse and trans clients across Sherbourne Health , the Systems Navigator provides information, community resources and referrals to ensure access to health and various community supports at the appropriate time in their transition. They provide advocacy and support, including brief supportive counselling to clients, collaborating with all members of the care team and partner organizations to ensure client access to care and resources.  The System Navigator develops links to community resources to meet the needs of the clients.  This position works with the primary care clinical staff and Accute Respite Care (ARC) staff, to seek out the appropriate resources and ensures that all clients receive respectful, competent and safe care and services.

scope and mandate:

The Systems Navigator coordinates care and provides support to gender-diverse and trans service users, and liaises with the primary care and ARC teams as well as community programs, in managing access to the various services.  They provide information, consultation and resources to clinicians and allied health providers in order to build capacity in providing competent care. The Systems Navigator liaises with service users and care providers, with the goal of improving engagement and continuity across services, to the end of positive health outcomes.

day to day responsibilities:

Systems Navigation:

  • Provides information, coaching, and mentoring regarding clinical pathways, referral options, and making appropriate referrals for transition related surgeries to providers, service users and family members
  • Collaborates with service users and their providers, e.g., participates in case review with providers, to assess needs and service options for clients
  • Follows up with clients and their caregivers to evaluate the services provided to ensure their needs are met
  • Establishes clients’ eligibility for specific services based on criteria of agency providing services (e.g., housing, ODSP, etc.) and where necessary advocates on the service user’s behalf
  • Engages with clients and their caregiver to understand what the service user and care giver deem as necessary services
  • Advocates for service users on an individual level to breakdown barriers to access services; encourages and supports clients and caregivers in self-advocacy
  • Maintains up to date knowledge of services and agencies for client referrals, including Sherbourne’s own programs and services
  • Assists clients in accessing equitable health care and essential social services and community resources, which may include responding to inbound phone inquiries or accompanying clients to specialist appointments
  • Researches programs, services, practices and professional literature for application in a direct services context. Maintains current knowledge of local, national and international trans health related services and resources

Case Management and Service User Support:

  • Establishes trust, confidentiality, credibility with clients
  • Reviews referral information and case histories, interviews service providers, referral agents and other sources, determines client risk factors for threats of harm to self and others, mental health issues and substance use
  • Coordinates referrals to gender affirming care and social supports. Where clients have complex needs, facilitates holistic care planning and coordination of input from a range of providers to support best outcomes for service users. Referrals may support access to counselling services, income assistance, housing, legal support, food, education, immigration support, employment training, disability assistance, clinical case management, mental health and addictions services, CCACs etc.
  • When necessary, provides brief supportive counselling to clients in distress
  • Maintains in-depth knowledge of gender affirming care pathways and service options to facilitate accurate information provision and referrals
  • Facilitates and participates in care coordination meetings and multidisciplinary case conferences as needed to support client access to care. Networks with internal and external service providers and builds collaborative relationships to support care planning
  • Maintains records in accordance with established procedures and policies, and prepares/maintains statistical data, correspondence reports and other documentation, as required

Partnership Development:

  • Conducts outreach and acts as organization liaison to establish and sustain positive and productive working relationships with clinicians and community partners and agencies
  • Monitors, maintains, and reports on client statistics and completion of operating plan activities
  • Actively participates in team meetings, Sherbourne committees/activities and on external committees as required
  • Other related duties as assigned

To thrive in this role, you’ll need


  • Masters of Social Work or other relevant health discipline
  • Minimum 5 years experience working with trans and non-binary individuals in a community health setting, or an equivalent blend.
  • Current registration with a regulated professional body (e.g. OCSWSSW, CNO).
  • Experience and knowledge of the health care system as it relates to the needs of gender-diverse and trans people, ideally gained in a primary care setting
  • Demonstrated understanding on the impacts of the social determinants of health; in particular, working knowledge of social support systems (e.g.  Ontario health and benefits systems, Toronto housing system, employment law as it relates to clients’ transitions)
  • Experience working in a multi-disciplinary team and collaborating with team on the care of clients.
  • Demonstrated initiative and experience working independently with minimal supervision.
  • Strong knowledge of anti-racist, decolonizing, and anti-oppressive understandings of gender-diverse and trans communities in Ontario, and the ability to speak to the health and social issues faced by diverse LGBT2SQ communities and in particular trans communities in Ontario, from these lenses.
  • Excellent interpersonal skills: verbal and written communication; ability to communicate effectively, respectfully, and compassionately with multiple audiences (including physicians, other clinicians, community members).
  • Be able to explain complex medical process in a simple language to clients in a time sensitive manner.
  • Experience building relationships with health care providers and organizations
  • Excellent organizational and time-management skills, ability to take on multiple responsibilities, meet deadlines and manage tasks and projects with minimal supervision
  • Ability to motivate, problem-solve and deal with complex issues with sensitivity and respect.
  • Demonstrated EMR (ideally Accuro) and software skills (MS Teams, PowerPoint, Excel).
  • Fluency in languages besides English an asset, especially French.
  • Demonstrates a commitment to a healthy and safe workplace for self and others (staff, patients, families, etc.) by taking all reasonable precautions and working in compliance with SHC related policies, health and safety legislation and best practices.

conditions of employment:

  • Offer of employment is contingent upon satisfactory outcome of background checks i.e., professional references, education verification, criminal background check, and vulnerable sector check.
  • Understands and works within the Occupational Health and Safety Act (OHSA), Personal Health Information Protection Act (PHIPA), Accessibility for Ontarians with Disabilities Act (AODA), the Ontario Human Rights Code and other relevant legislation.

working conditions:

The System Navigator works in the primary care clinical area. Given the nature of the role they may face interruption and disruption to any established daily routines.  The System Navigator may be required to intervene with difficult situations involving people who use drugs and/or alcohol , and/or have mental health challenges. Some evenings and/or weekend hours will be required.  It is crucial that all client and organizational information is kept confidential at all times.

to apply:  Please forward a cover letter and resume quoting Job ID #LGB SN 21-1123 to by December 5, 2021.

Sherbourne is dedicated to building an organization that reflects the diversity of our clients and the communities we serve. This includes diversity in languages spoken, culture, race, sexual orientation and gender identity. Requests for accommodation due to disability can be made at any stage in the recruitment process.

We thank all applicants for their interest but only those selected for further consideration will be contacted.

BOLD.                   KIND.                     REAL.                    OPEN.                    WE CARE.

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