Specialist, Reimbursement

2 weeks ago

Toronto, Canada Ontario Health Full time

At Ontario Health, we are committed to developing a strong organizational culture that connects and inspires all team members across the province. Our vision is that together, we will be a leader in health and wellness for all. Our mission is to connect the health system to drive improved and equitable health outcomes, experiences and value. How we work together is reflected through our five values: integrity, inspiration, tenacity, humility and care.

What Ontario Health offers:

- Achieving your career goals is a priority to us. Benefits of working at Ontario Health may include the following based on employment type:
- Fully paid medical, dental and vision coverage from your first day- Health care spending account- Premium defined benefit pension plan- 3 personal days and 2 float days annually- Individual contributors start at 3 weeks’ vacation with 4 weeks at 2 yrs.- Career development opportunities- A collaborative values-based team culture- Wellness programs- A hybrid working model- Participation in- Communities of InclusionWant to make a difference in your career? Consider this opportunity.
- The Provincial Drug Reimbursement Programs (PDRP) unit at Ontario Health administers several cancer drug and service adjudication and funding programs on behalf of, or in support of, the Ministry of Health (ministry). These programs advise the ministry on the clinical and cost-effectiveness of new expensive drugs and other emerging therapies, and implement an equitable and transparent provincial operational model for patients to get access to these treatments when they meet eligibility criteria.
- PDRP’s responsibilities include administration of the New Drug Funding Program (NDFP), the High Cost Therapy Funding Program (HCTFP), the Evidence-Building Program (EBP) and the Case-by-Case Review Program. PDRP administers Ontario Health’s Out-of-Country programs, providing access to cancer drugs, services and genetic testing. PDRP adjudicates funding requests for CAR T-cell therapy, offers an Evidence Search and Review Service, supports the Ontario Health Infectious Diseases Advisory Committee, and is the home of the Canadian Cancer Real-World Evaluation (CCRE) Platform, a Core Network Partner of the Canadian Agency for Drugs and Technologies in Health (CADTH)’s post-marketing drug evaluation program, CoLab.
- The Specialist is responsible for the day-to-day operations of PDRP’s population-based funding programs (NDFP, EBP, HCTFP), ensuring that patients have access to treatments without delay, and are the primary points of contact for our partners in close to 80 Ontario hospitals and cancer centres. The Specialist supports the Managers, Pharmacists and other program staff in delivering on the mandates of the programs, within specific areas of expertise by executing key activities and developing the required deliverables. The Specialist supports the development of the required policies (including implementation of new therapies), processes, tools, and technology to implement these key activities and deliver on program operations and initiatives.
- The Specialist supports programs that are large and broad in scope, and are related to more than one focused area of expertise. The work associated with the position impacts the success of the program and the overall business unit based on the accomplishment of key responsibilities and activities within areas of expertise.
- The Specialist regularly liaises with staff throughout Ontario Health (other clinical programs, Legal and Privacy Office, Finance, Communications, Information Technology and Analytics). They may also engage with clinicians, hospital administrators, the ministry, and other key stakeholders across the province.

Here is what you will be doing:

- Program / operational support- Refine tools that leverage best use of technology and enable highly efficient program operations.Adjudicate enrolments and treatments for high-cost therapies to align with accounting best practice and payment of monthly invoices in a timely manner.-
- Work collaboratively with internal team members (clinical and technical staff), clinical expert reviewers and the ministry to support the timely implementation of new drug funding policies.-
- Support a measurement plan and evaluation framework to monitor program operations that will enable operational excellence in program delivery. Analyze quantitative and qualitative data, and prepare reports and presentations as required.-
- Identify technical needs, provide input into business requirements and work with colleagues to develop and test enhancements on electronic tools.-
- Work with clinical experts and other clinical program staff to create, revise, and clarify eligibility criteria on high-cost therapies.-
- Support, prepare materials for, and present at meetings, conferences, working groups, advisory committees and steering committees as required.-
- Perform cross-functional tasks and other duties, as required.- Communicat

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