Health Services Program & Provider Specialist

Workplace Safety and Insurance Board (WSIB); Toronto; On-site; CAD 104,000 - 120,000; Full time

Job summary

A government agency in Ontario is seeking a Quality Management Specialist to enhance healthcare quality services. The candidate will design and implement quality management programs, conduct audits, and collaborate with healthcare providers to ensure compliance with service standards. A master's degree in a regulated healthcare profession and 4 years of relevant experience are required. This temporary position offers a competitive salary and opportunities for professional growth.

Benefits

Competitive salary

Health and dental plan

Professional development opportunities

Qualifications

• 4 years of experience in quality management in healthcare.
• Experience in nursing, physiotherapy, occupational therapy or chiropractic studies.

Responsibilities

• Design and implement quality management programs.
• Conduct audits and ensure compliance with service standards.
• Provide education and consultation to staff and healthcare providers.

Skills

Quality management

Clinical knowledge

Data analysis

Interpersonal communication

Education

Masters in a regulated healthcare profession

Tools

Performance measurement tools

Job description

About the Workplace Safety and Insurance Board (WSIB)

We’re here to help. When an injury or illness happens on the job, we move quickly to provide wage-loss benefits, medical coverage and support to help people get back to work. Funded by businesses, we also provide no-fault collective liability insurance and access to industry-specific health and safety information. We are one of the largest insurance organizations in North America covering over five million people in more than 300,000 workplaces across Ontario. For more information, visit wsib.ca.

At the WSIB, you’ll have the opportunity to :

• explore many career paths and follow your passion
• continuously learn and grow professionally
• be recognized for the great work you do
• participate in programs that support your health and wellbeing

You’ll also receive a competitive salary and may be eligible to participate in our health and dental plan.

This is a temporary opportunity up to 13 months in duration

Salary Grade: 214 From : $104,118.25

Job Summary

Contribute to organizational and service excellence of Health Services Program & Provider Effectiveness Branch, the health care strategy by designing, implementing, monitoring and evaluating a quality management program using clinical knowledge and expertise that will ensure quality of services provided by contracted health care providers (e.g., through Occupational Health Assessment Programs (OHAP), Specialty Programs (SP) and non-contracted health care providers (e.g. through Programs of Care, Community Mental Health Program 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 recommendations are appropriate; identify any performance gaps and recommend solutions. Provide education , 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. OHAP, Specialty Programs, 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 includes analyzing data using collected data, reports, and / or data obtained from providers and and / or internal sources (e.g. CBIA) and reporting on key performance indicators and / or clinical outcomes.

2.Respond to program inquiries related to program and / or claim issues raised by case management teams, management, contracted and non-contracted health care providers and others. This includes using WSIB systems to review claim information and collaborating with providers 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. As a subject matter expert act as a resource WSIB staff, Health Care providers in the province of Ontario and other external providers, fielding questions related to Health Care Programs.

3.Support development and / or implementation of existing or new Health Care Programs including program components and structure, materials, form and report template design, and communications. This may include participating in delivering the content material (e.g. participate in presentations to professional associations).

4.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 (e.g. onsite meetings and / or monthly teleconferences);
• 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.

5.Develop tools and 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, develop data collection and / or reporting tools, 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.

6.Prepare reports, which include analysis of clinical programs, services and providers. This includes analysis of findings of clinical reviews, and compliance with service level agreements (SLAs) and / or adherence with contract standards as well as recommendations addressing gaps in program delivery.

7.Provide presentation of key performance indicators, outcome measures and / or program trends to inform management, recommending audits and program development opportunities; and monitor performance management plans to assist providers in meeting service level standards or service expectations Recommend program improvements, such as process changes and additional provider training.

8.Audit individual cases to ensure appropriate health care services were provided and adhere to program expectations, contractual obligations, and / or established quality framework.

9.Develop program training material and deliver content as required. Participate in training internal and external groups on Health Services programs, services, processes.

10.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.

11.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.

12.In addition to individual work, a key component includes working in a collaborative, interdisciplinary team-based environment in delivering the quality management program (e.g. developing and conducting audits, program development). This collaboration can also extend to internal WSIB teams, and / or external providers or professional associations.

13.Perform other related duties as assigned or required.

Job Requirements

Education

• University completion at the post graduate level with a Masters in a regulated healthcare profession. (i.e. Registered Nurse, Physiotherapy, Occupational Therapy or Chiropractic studies).

Experience

• Four years prior experience in quality management and clinical environment in nursing, physiotherapy, occupational therapy or chiropractic studies.

Our commitment to equity, diversity and inclusion

We respect and value the diversity of our people. We strive to create an environment where employees can be themselves and where our differences are celebrated.

We value and celebrate diversity and are committed to creating inclusive experiences for both our employees and prospective employees. We invite all interested individuals to apply. If you require accommodations in order to apply to this position please contact [e-mail]. If you are invited to participate in the interview or assessment process, you can advise our Recruiter of your accommodation needs at that time.

Please visit ourEDI Visionto learn more about what actions WSIB are taking to advance our commitment to equity, diversity and inclusion and to support all employees participating and contributing to their full potential