NSW Health is currently in the process of transitioning to a new Recruitment & Onboarding system. 

During the transition period, some job roles and disciplines (eg, Medical) may be posted across two different locations.

In addition to reviewing this site, please review https://jobs.health.nsw.gov.au to ensure you see all advertised roles.

Position Details
Reference Number 394924
Position Title Aboriginal Care Facilitator, Western Sydney Integrated Chronic Care Program
Employment Status Permanent Full Time
Entity Western Sydney Local Health District
Geographical Location Blacktown
Advertised Award/Classification Clinical Nurse Specialist Grade 2
Salary $93,556.00 - $96,624.00
Number of FTE 1.00
Purpose of Position

Development and utilisation of a shared care plan is central to the successful provision of integrated care for people with chronic disease as it facilitates effective communication between service providers and has mutually agreed goals and actions to be undertaken by all parties.

The Care Facilitator is central to the delivery of the planned care and the shared care planning process, inclusive of systematically monitoring relevant clinical and psychosocial metrics and an individual’s social determinants of health to identify a deterioration in a patient’s condition.

Dependent on the patients’  level of needs or risk the Care Facilitator will be responsible for the care facilitation of or access to one of the following interventions:

Usual care – the full range of patient care options that a clinician could choose to provide or offer to meet an individual patient’s needs, such as medication reviews, and referral to specialist, social care, rehabilitation and community nursing services.

Care navigation – provides information and referral support that enhances timely access, for example, between primary and specialist care, for diagnostics and for social support, as well as ensuring timely review. Care navigation can be delivered via telephone by a non-clinician.

Care coordination – provides support in the identification of patient-level clinical requirements, the communication of clinical information across the care team (including the shared care plan, routine clinical assessment and uploading of clinical metrics) and tracking of follow-up to care plan. The person delivering care coordination has a clinical background, e.g. in nursing, social work, or allied health; is familiar with a range of medical conditions, health services and medical terminology; and is capable of writing clinical notes. Service is principally delivered by telephone or electronically. Care coordination can be based in hospital, community care or primary care.

Care management – works closely with care plan custodians, provides complementary clinical assessment as part of care planning and supports follow-up systematic assessment of the patient. The care manager may be responsible for a defined case load of enrolled patients and/or picking up referrals based on clinical deterioration following ED presentation, hospitalisation, or at the request of the specialist or GP care plan custodian. The person delivering care management has a clinical background, e.g. in nursing, social work, or allied health; usually with several years of clinical practice experience or advanced training. Service is delivered primarily face to face with a patient and is primarily in a home or clinic setting. Care management can be based in hospital, community care or primary care.

Health coaching – provides services in health literacy, patient activation and motivation, psychological aspects of illness impacting health status and adherence to care plans, and self-management skill building. The person delivering health coaching is a psychologist, social worker, or has undergone training in health coaching. Service delivery may be by telephone or face to face and is primarily in the home or clinic setting. Health coaching can be based in hospital, community care or primary care.


We are seeking a Registered Nurse who identifies as a person of Aboriginal or Torres Strait Islander descent and who is accepted as such by their local Aboriginal community to work in a newly established role of Aboriginal Care Facilitator across Western Sydney Local health District


The successful applicant will need to have high level clinical nursing knowledge, experience and skills in providing complex nursing care to Aboriginal People with chronic disease. The role is responsible for providing care coordinator across the continuum of chronic disease management involving inpatient community and primary care based services.


If you have skills in nursing leadership and a an aspiration to participate in the development of chronic disease nursing specialty clinical practice and service delivery to the wider clinical team of the newly amalgamated Integrated Chronic Care Management Program then please apply.


People with disabilities who meet the selection criteria are encouraged to apply; and where required, WSLHD will implement reasonable adjustment consistent with industry standard.


Stepping Up aims to assist Aboriginal job applicants by providing information about applying for roles in NSW Health organisations.  For more information, please visit: http://www.steppingup.health.nsw.gov.au/. Aboriginal and/or Torres Strait Islander people are encouraged to apply.


This position is permanent full time, working 38 hours per week and is classified as a Clinical Nurse Specialist Grade 2.


Please note: To be eligible for permanent appointment to a position in NSW Health, you must have an Australian citizenship or permanent Australian residency.


This is an Aboriginal Identified position.  Please see selection criteria.  An applicant's race is a genuine occupational qualification and is authorised under Section 14(d) of the Anti-Discrimination Act 1977, NSW.

Selection Criteria 1. Current Registered Nurse division 1 Australian Health Practitioner Regulation Agency (AHPRA) with at least three (3) years relevant full time equivalent post registration experience working in the clinical area of chronic disease management inclusive of care coordination and self-management support. Current valid drivers licence within Australia and willingness to use for work purposes.

2. Post-graduate qualification specific to chronic disease management relevant to performing this role of Clinical Specialist Grade 2.

3. Demonstrated ability to provide leadership in the provision and development of clinical practice by utilisation of evidence based research with a demonstrated understanding of current NSW Health Policies related to Chronic Disease Management, accompanied by a knowledge of General Practice.

4. Demonstrated ability to communicate effectively with patients, carers and a diverse range of health care providers including those in government, non-government and community organisations.

5. Demonstrated ability to work within a multidisciplinary team, with an emphasis on service delivery, quality of care and team cohesion with an ability to identify and improve opportunities to enhance continuity of care between the acute sector, primary care providers and community based services.

6. Demonstrated knowledge of and ability to utilise information technology systems within a variety of applications.

7. This is an identified Aboriginal Position. Applicants must be of Aboriginal and / or Torres Strait Islander descent, have demonstrated knowledge and understanding of Aboriginal and Torres Strait Islander cultures and have established links with their local Aboriginal community. Exemption is claimed under Section 14d of the Anti-Discrimination Act 1977, NSW.

8. Preparedness to be flexible and adapt to changing role requirements as the service develops operationally.
This position requires a Working With Children Check (WWCC) issued by the Office of the Children's Guardian. For more information on how to apply for the clearance, please visit the Office of the Children's Guardian website www.kidsguardian.nsw.gov.au/Working-with-children/working-with-children-check
Contact Person Jo Medlin
Contact Number 0434565839
Contact Email Joanne.Medlin@health.nsw.gov.au
Closing Date 19/07/2017
Supporting Documents
Position Description click here to view
Application Guide click here to view