Health Services Program

3 weeks ago

Toronto, Canada Workplace Safety and Insurance Board Full time

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/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

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 ex

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