Health Services Program & Provider Specialist
Toronto, ON, CA
6d ago

Job Summary :

Contribute to organizational and service excellence of Health Services, the Health Care Strategy and the Compliance Strategy by designing, implementing, monitoring and evaluating a quality management program that will ensure quality of services with emphasis on clinical quality provided by contracted health care providers (e.

g., through Regional Evaluation Centres, Specialty Clinics) and non-contracted health care providers (e.g. through Programs of Care and other health care programs and initiatives) and overall performance against established standards and / or service level agreements.

Establish targets for providers and programs and ensure that they are being achieved.

  • Conduct comprehensive audits at the program and provider level as well as individual cases to ensure health care interventions are appropriate;
  • identify any performance gaps and recommend solutions. Provide advice, direction and consultation to WSIB staff and management regarding the appropriateness of health care and return to work recommendations and advice about health care professionals delivering services within their scope of practice outlined within their respective Colleges.

    Major Duties & Responsibilities :

    1. Using quality management strategies / principles, design, implement, monitor and evaluate the services of health care providers through a quality management program to ensure that programs (e.

    g. Regional Evaluation Centres, Specialty Clinics, Programs of Care, other health care programs) and providers are outcome focused, timely and cost effective and directed to return to work through an effective quality management program.

    This will include analyzing clinical outcomes data submitted by the health care providers using various outcome measurement tools, such as DASH , Beck Depression Inventory, SF-

    36 or Sheehan Disability Scale, and reporting results.

    2. Manage day-to-day issues raised by Service Delivery staff and management, health care providers and others. This includes conducting the clinical review process to ensure workers referred to programs receive sound, clear, best evidence-

    based recommendations and treatment interventions that achieve WSIB standards and timely resolution of issues.

    3. Monitor, evaluate and oversee provider and program performance to ensure quality and service standards are being maintained. This includes :

  • Reporting on provider performance relative to service level agreement (SLA), worker satisfaction and program objectives to ensure WSIB is obtaining the maximum value from contracts and / or standards;
  • Identifying quality improvement opportunities and developing recommendations / options as appropriate;
  • Assessing and determining acceptable action plans to address any identified deficiencies in service levels;
  • Communication with providers to discuss their performance, current scorecard and action plan for remediation;
  • Monitoring results of implemented action plan and recommending to management corrective action which could include possible penalties and suspension of contract;
  • In collaboration with the WSIB management, prepare and present findings on identified trends, outcomes and recommendations to WSIB senior management as well as to senior management of programs under review.
  • 4. Use databases to capture data and monitor progress for the quality management programs and other initiatives. Conduct reviews of data obtained from various data tools (e.

    g. performance measurement tool, monthly statistical reporting tool, Cognos, etc.) to identify trends and anomalies in billing, timeliness of referrals, accessibility, utilization, etc.

    Develop reports including recommendations for presentation to management using qualitative and quantitative measures.

    5. As a technical resource, provide reports on clinical programs, services and providers, which include analysis, findings of clinical reviews, compliance with service level agreements (SLAs) and / or adherence with contract standards as well as recommendations addressing gaps in program delivery.

  • Provide presentation of key performance indicators to management for discussion with providers, recommending audits and program development opportunities;
  • and recommend and implement performance management plans to assist providers in meeting service level standards or service expectations.

    6. Audit individual cases for appropriateness and outcomes of the provided health care to workers and provide feedback to management with recommendations for program improvements, such as process changes and additional provider training.

    7. Develop training material on programs or services and deliver content as required as subject matter expert. Participate in training providers on WSIB programs, services and processes based on findings from the quality management program.

    8. Assist management in the contract initiation and renewal process by preparing Requests for Proposals (RFPs) or Requests for Information to solicit services for renewal of contracts or new provider contracts.

    Collaborate with Legal Services and Finance to negotiate and produce new contracts including incorporating fee schedules, performance measurement standards.

    Collaborate with Finance and Purchasing to review and evaluate RFP responses to select providers; provide advice in the determination and recommendations on contract renewals to ensure workers’ and WSIB needs are being met.

    9. Lead and / or participate in project teams involving health care strategy. Collaborate with others within the Health Services Division and throughout the organization to ensure work is aligned and integrated.

    10. Perform other related duties as assigned or required

    Job Requirements :

  • University completion at the post graduate level with a Masters in a regulated healthcare professions. (i.e. Registered Nurse, Physiotherapy, Occupational Therapy or Chiropractic studies).
  • Total of seven years and six months experience. Four years prior experience in quality management and clinical environment in nursing, physiotherapy, occupational therapy or chiropractic studies.
  • Three years and six months experience on the job experience to reach full working level.

    As a precondition of employment, the WSIB will require a prospective candidate to undergo a criminal records name check prior to or at any time following hire.

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