Job Specification

Purpose of Position :

To research and advise on clinical, medical and technical implications with respect to the development, implementation and maintenance of accountability agreements and contracts with provincial and individual providers and health care organizations, including the provision of advice on the development and engagement of external stakeholders and the management of the accountability relationship. To lead/participate on working groups, cross functional teams and expert panels.

Duties / Responsibilities :

The Health Services Branch has the mandate to manage the operational and accountability programs for physicians and practitioners who provide insured services through fee-for-service through specialty contract alternative payment and other contractual payment programs. In this context, the position:

1. Develops, in conjunction with the Senior Medical Consultant, objectives, criteria and strategic work plans for the development, implementation and maintenance of accountability agreements and contracts. Makes recommendations on the formulation and/or changes to the development of program and related policies, assesses projected challenges, limitations and opportunities, and reviews high level plan with stakeholders for revision purposes.

2. Manages and facilitates complex and highly politically sensitive relationships and partnerships. Provides insight into accountability agreement development and management. Promotes clear and open line of communications. Provides consultation, advice, expertise and interpretation/application of complex medical terminology or clauses within proposed mandates, agreements/contracts, and potential strategies.

3. Participates and/or leads committees and cross-functional working groups. Represents the Branch/Ministry as an authority for decisions regarding clinical, medical and technical aspects related to the development, implementation and maintenance of accountability agreements and contracts. Ensures quality, accuracy and comprehensiveness of advice and recommendations. Reports to. the Senior Medical Consultant on proceedings.

4: Participates in the analysis of medical claims received from physicians and practitioners, including aberrant billing patterns, deviations In billing practices, services provided but not medically acceptable/necessary, services that do not meet accepted professional standards, and review of Out-Of-Country applications for medical services, etc. Presents reports to the Senior Medical Consultant for submission to the Regulatory Committee(e) and Boards. Appears as witness and represents the Branch at hearings, Appeals Boards, and the Court.

5. Manages and/or coordinates the analysis, prioritization and response to clinical and change management issues relating to the development, implementation and maintenance of accountability agreements and contracts. Responds and/or coordinates the preparation of formal replies, briefing/House notes, comprehensive reports, discussion documents, business requirements and assists with Cabinet submissions, public program statements and consultation papers which may lead to statutory or regulatory changes. Presents options, recommendations or remedial actions to the Senior Medical Consultant.

6. Coordinates/conducts research and analysis related to health system/program trends, practices, theories and related clinical, medical and technical implications the context of the Branch/Ministry's strategic directions.

7. Develops, in concert with professional communicators, communications tools/products to support the development, implementation and maintenance of accountability agreements and contracts. Formulates communications content and format and ensures the proper delivery to stakeholders/recipients (e.g. tools/products include, but are not limited to Bulletins, Q&As, Facts Sheets, web/Intranet information, briefings, etc.).

8. Assists the Senior Medical Consultant and Branch senior management in managing the review, development and implementation of operational policies, directives, procedures, processes, quality assurance with respect to accountability agreements and contracts.

9. The Senior Medical Consultant has the right to assign additional duties.

Knowledge :

Position requires a medical degree from a university of recognized standing, a current valid license to practice medicine in the Province of Ontario and experience in specialized medical consultation or administration/preferably certification in a specialty of family medicine, community medicine, to provide medical expertise and leadership in the development, implementation and maintenance of accountability agreements and contracts. Knowledge of the health care system, health care delivery and physician remuneration methods under OHIP; knowledge and understanding of Ontario's legislative authorities and related Ministry policies impacting the medical profession in relation to various compensation programs (e.g. Health Insurance Act, Primary Care, to: ensure medical consultative expertise and advice is consistent with Ministry and government directions and policies; research and advise on clinical, medical and technical implications with respect to the development, implementation and maintenance of accountability agreements and contracts. Knowledge of and experience with .corporate and Ministry health policy and decision-making processes as well as Ministry and Branch's programs, legislation, policies, goals and objectives, to recommend on the formulation and/or changes to the development of the program/policies, assess projected challenges, limitations and opportunities, and review high level plan with stakeholders for revision purposes. Considerable knowledge of management theory, and organizational dynamics, to appropriately assess and follow-up on issues in a timely fashion. Knowledge of project management and research methodologies/techniques, and leadership skills, to ,manage and lead project working groups (e.g. prepares working group action plans, provides input into project charter development and manages project teams). Consultative, relationship management, communications and presentation skills, to: build, manage and facilitate highly politically sensitive relationships and partnerships; provide consultation, advice, and interpretation of accountability agreements and contracts; prepare formal replies, briefing/House notes, comprehensive reports, discussion documents, consultative papers, etc. Strategic analytical and issues management skills, to: manage and coordinate the analysis, prioritization and response to issues with a focus on medical, clinical and technical issues/matters. Computer proficiency to access the Internet as a research tool and to prepare own materials using various software programs.

Judgement :

Position works under the general direction of the Senior Medical Consultant, and within the broad framework of legislative authorities and the Ministry policies and protocols governing the accountability agreements and contracts between the province, individual providers, and health care organizations. Judgement is required in providing strategic advice, options and recommendations to the Senior Medical Consultant and Branch senior executives with respect to the development, implementation and maintenance of accountability agreements and contracts. Position exercises considerable judgement in a variety of leadership and management roles (e.g. managing the review, development and implementation of operational policies, directives, procedures, processes, quality assurance, communications tools/products, etc.) which are critical to the successful implementation and maintenance of accountability agreements and contracts, Position exercises significant 'judgement in managing and coordinating the analysis, prioritization and response to issues and in presenting options and/or recommendations on remedial actions to the Senior Medical Consultant. Position uses political acuity in recognizing sensitive !political situations and ensuring that work activities do not, in any way, negatively impact on the Branch and Ministry's mandate and objectives.

Accountability - Programs :

Position assists the Senior Medical Consultant and Branch senior executives, and makes significant contributions to the research, development, analysis, implementation and maintenance of provincial accountability agreements and contracts. Position works in conjunction with and provides advice and recommendations to senior executives, managers, work teams, the medical community (e.g. professional associations and government bodies) and makes recommendations for senior executives decision-making.

Accountability – Personnel :

Position provides leadership and technical direction to project staff, line ;management and senior executives with respect to the accountability agreements and contracts.

Accountability - Impact of Errors :

Errors in judgment and the inaccurate analysis of the program context could prevent the Branch and the Ministry from effectively 'developing and implementing accountability agreements and contracts, and therefore, negatively impact on strategic directions and priorities of the Branch and Ministry. Such errors could result in inefficient use of resources and the loss of credibility for the Ministry and the Branch.

Contact - Internal :

Frequent ongoing contact with Ministry senior executives, managers, colleagues, Medical Consultant peers, and other Ministry divisions/branches, to: provide expertise, advice and recommendations on clinical / medical I technical issues; provide implementation and project management advice; ensure effective liaison and linkages; provide issues management; discuss matters of mutual concerns; obtain, provide and share information. Position leads and/or participates on committees/cross-functional working groups.

Contact - External :

Frequent contact with a broad range of external stakeholders, including the medical community (e.g. professional associations, government bodies and agencies, regulatory committees and boards, colleges, academic and research institutions), to discuss clinical/medical/technical issues; provide expertise and provide authoritative advice with respect to accountability agreements and contracts; obtain, provide, share information. Contact on an as-needed basis with OPP and Tribunals to discuss fraud in billing and appear as witness and represent the Branch at hearings, Appeals Boards and the Court. Position leads and/or participates on committees/cross-functional working groups.