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Job Specification
Position Title: CASE OFFICER
Job Code: OPSEU - Office Administration 11, 11OAD
Job ID: 21652

Purpose of Position:
To perform comprehensive case management and processing of appeals to a number of adjudicative agencies supported by the Health Board Secretariat (e.g. the Health Professionals Appeal and Review Board, the Health Services Appeal and Review Board, the Ontario Hepatitis C Appeal Program Review Committee and the Transitional Physicians Audit Panel).

Duties/Responsibilities:
Incumbents are assigned to cases based on work demand and volume, and the position:
1. Performs case management of assigned appeal and review files from intake to resolution of the file including
review of case documents and submissions to determine their eligibility for review or hearing based on the interpretation and application of diverse jurisdiction and legislative mandates of various agencies; determining case prioritization; scheduling and coordination, case monitoring, document coordination and management through to disclosure and review.
2. Develops and maintains ongoing liaison as the key and primary point of contact for parties (e.g. OHIP, health
professionals), public and Board Members regarding assigned cases. Initiates contact with appellants and other parties to obtain additional information and documentation required for case to proceed or to advise of an alternative course of action. Responds to a range of inquiries from appellants and Board members regarding the role of the Boards, case eligibility, Board expectations and the interpretation and` application of a range of policies, practices, guidelines or procedures impacting case outcomes. Ensures compliance with Secretariats and Boards performance objectives for customer service, quality and professionalism in handling often complex and highly personal matters containing confidential personal health information.
3. Maintains assigned cases within the case management system and manages the flow of case documents through the case lifecycle including the identification and resolution of highly technical, unique and contentious cases which have potential critical impact and risk. Monitors assigned files; prepares daily updates and tracks progress of cases to reduce potential for backlog; determines need to bring files forward and initiates contact with the responsible Board member to ensure that the cases are processed within prescribed or legislated time constraints.
4. Schedules and coordinates all aspects of the hearing/review (i.e, arrangement of hearing room, confirmation of partys attendance, preparation and distribution of case documentation to parties and Board panel) within established legislative timeframes. Prepares the facilitator or member by clarifying file details, scheduling requests, and highlighting potential issues/risks without releasing information that may create an apprehension of bias. Identifies and arranges ancillary services (i.e. security, interpreters, court reporters, audio-visual equipment),
5. Works closely with administrative assistants to coordinate photocopying, courier and distribution of often large volumes of highly confidential documents required by all parties prior to a hearing/review.
6. Determines a plan in consultation with the Board panel post review/hearing for the management of the decision process including outlining a time frame for the draft decision. Follows up with Board Members to ensure performance metrics are met. Formats decision documents, issues to parties and records electronically and administratively. Performs electronic and administrative functions to close the case file.
7. Provides statistical reports and analysis related to assigned case load upon request.

Knowledge:
Job requires knowledge of:
Quasi-judicial and adjudicative Board policies, practices, procedures and guidelines and the mandate of the Health Board Secretariat to provide case management and processing of appeals before the Boards.
Legislative mandates of the Health Professions Appeal and Review Board, the Health Services Appeal and Review Board, the Ontario Hepatitis C Appeal Program Review Committee and the Transitional Physicians Audit Panel to determine eligibility of hearings before various boards and to manage assigned case files.
Relevant legislation (e.g. Ministry of Health Appeal and Review Boards Act, Health Insurance Act, Regulated Health Professions Act, Statutory Powers and Procedures Act, Charter of Rights and Freedoms and Ontario Human rights Code) pertaining to the multiple Boards and other committees to interpret and apply a range of legislative authorities throughout the case management processes and when responding to inquiries regarding administrative requirements for filing a matter with the Boards or Committees and/or inquiries regarding the Boards policies, processes, procedures, and guidelines.
Legislative authorities pertaining to the privacy of personal information (e.g. FIPPA, Health Information Protection Act) and the Human Rights Code to ensure compliance in response to case related inquiries and management of cases.
Health Board Secretariat case management procedures and protocols to conduct the management and processing of assigned appeal and review files from intake to resolution of the file
Health Board Secretariat case management procedures and protocols to conduct the management and processing of assigned appeal and review files from intake to resolution of the file
Use and capabilities of the Case Management system to maintain assigned cases within the case management system and manage the flow of case documents through the case lifecycle.
The Secretariats customer service principles and the shared resource model to provide services within the Secretariats performance objectives for customer service, quality and professionalism.
Use and capabilities of standard computer software to prepare correspondence and case materials and to generate reports and to operate a case management system for tracking all facets of case files.

Skills:
Job requires:
analytical skills to review new appeal requests containing often complex documents involving medical, health and legal terminology to identify and assess cases, determine whether the appeal is within the jurisdiction of the applicable Board, case eligibility for hearings and potential issues for further review and resolution.
Analytical skills to interpret and apply a broad variety of statutory provisions under the applicable legislative authorities and the Board policies, procedures, practices and guidelines when responding to inquiries, advising Board Members and appellants; reviewing case documentation and ensuring compliance through all stages of the case management process.
Diplomacy, interpersonal and problem solving skills to assess and respond to a wide range of very sensitive matters when dealing with the diverse expectations, needs, culture and language of clients, whom are often not represented by counsel and dealing with high levels of personal stress due to the nature of their submissions to the Boards.
Information processing skills to compile, code, categorize, calculate, tabulate, audit, verify or process information and data. Organization, planning and prioritization skills to prioritize, organize and accomplish ones own work and to effectively manage a large case load of active files requiring ongoing tracking, follow up and scheduling, and to schedule hearings in the most efficient and cost effective manner possible taking into consideration priority of appeal, probable duration of review, geographic location.
Interpersonal skills and cultural competence to work effectively with individuals from different cultural and ethnic background and those with special needs to ensure parties and representatives receive appropriate customer service in individual cases.
Oral communication and listening skills to listen and understand information and ideas presented through spoken words and to communicate information and ideas so that others understand
Interpersonal skills and team player skills to work cooperatively within the HBSs shared resource model to accomplish tasks. Oral and written communication skills to respond orally and in writing to a range of inquiries regarding the role of the Boards, case eligibility, board expectations and rules of practice and to maintain ongoing contact with all parties throughout the case life cycle as the Boards primary point of contact.

Freedom of Action:
Job requires working within the Boards related legislation, its. policies, practices, guidelines and procedures, the mandate of the Health Board Secretariat and applicable legislative authorities governing the role of the boards and protection and disclosure of personal information, As the key and primary point of contact and lead on assigned cases, position requires latitude in decision making to ensure all phases from intake to resolution of the file are effectively managed, all materials are accurate, thorough and complete. Job requires reviewing new appeal requests and assessing their eligibility within a diverse range of legislation, prioritizing requests and maintaining case ineligibility lists with applicable rationale. Job requires planning, scheduling and coordinating hearings based on availability of participants and resources subject to assessments and prioritization and ensuring timeliness of all distributed documentation to panel members for adequate support prior to hearings. Due to the nature of the work and the range of parties requiring ongoing contact, the job is required to maintain a high level of professionalism and discretion in its external relationships with parties and their representatives to appeals and reviews such as the Regulatory Colleges, appellants and respondents, their legal counselor representatives, service providers such as interpreters and members of the general public who rely heavily on both the information provided by the Case Officer and the resultant scheduling of their hearings. Job requires monitoring and controlling the flow, coordination and management of all documents which are highly confidential and in maintaining the case management system to ensure appropriate follow up and tracking of files for timeliness of cases, quality of material and scheduling of hearings. Job requires determining a plan in consultation with the Board panel post review/hearing for the management of the decision process including outlining a timeframe for the draft decision. Job requires recognizing when there is or may be a problem, assessing the risk and proposing a solution or determining when immediate action and escalation of a matter is required to minimize risk to the Boards and Secretariat. Job is expected to work independently, handling all issues and only advising the Deputy Registrar of potentially high impact cases for mutual problem solving or discussing work load pressures.