Senior Specialist, Reimbursement & Quality Improvement

Pour recevoir une copie de cette offre d’emploi en français, veuillez nous contacter à careers@ontariohealth.ca . Nous répondrons à votre demande dans un délai de trois jours ouvrables et cela n'aura aucune incidence sur votre capacité à postuler à ce poste.

To receive a copy of this job posting in French, please contact us at careers@ontariohealth.ca . Your request will be responded to within three business days and will not impact your ability to apply for this role.

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:

1. Fully paid medical, dental and vision coverage from your first day
2. A health care spending or wellness spending account
3. A premium defined benefit pension plan
4. Three personal days and two float days annually
5. Three weeks’ vacation to start (for individual contributors), increasing to four weeks after two years
6. Career development opportunities
7. A collaborative values-based team culture
8. A wellness program
9. A hybrid working model
10. Participation in Communities of Inclusion

Want to make a difference in your career? Consider this opportunity.

The Provincial Drug Reimbursement Programs (PDRP) administers several cancer drug funding and case adjudication programs on behalf of the Ontario Ministry of Health. 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 and services. 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 Canada’s Drug Agency (CDA) and their post-marketing drug evaluation program, CoLab. As part of the Acute and Hospital-Based Care portfolio at Ontario Health, PDRP provides timely access to high-cost cancer treatments and services, while ensuring the rational use of limited health resources. 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 access these treatments based on established eligibility criteria.

Reporting to the Manager, Provincial Drug Reimbursement Programs, the Senior Specialist, Reimbursement & Quality Improvement, is responsible for providing authoritative advice to internal and external stakeholders on their specific area of expertise. In this role, the Senior Specialist supports the business unit with the design, implementation, and ongoing evaluation of quality improvement initiatives. This includes a continual assessment of all drug funding policies, processes, tools, and technology to deliver on program operations and initiatives more efficiently. The Senior Specialist will also play an integral role in the development and maintenance of reportable key performance indicators (KPIs) and may be asked to support an audit framework to ensure adherence to individual policy requirements. The Senior 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 of the business unit, which includes but is not limited to, enhanced reporting to the ministry based on an established framework.

The Senior Specialist is focused on projects/programs/operational areas that are large and broad in scope, have more complex mandates/objectives, and/or 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 Senior 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 health system partners across the province as required.

Key areas of responsibility include:

1. Strategic planning
2. Program/Operational support
3. Stakeholder engagement

Here is what you will be doing:

1. Drive the conceptualization, development, and implementation of tools to enable highly efficient program operations while promoting transparency in adjudication practices.
2. Support the manager, and other team members in the development and maintenance of program policies to ensure completion of deliverables on time and escalate project risks as appropriate.
3. Support the adjudication of enrolments and treatments for high-cost therapies to facilitate timely reporting for financial reconciliation.
4. Lead the analysis of operational policies and processes to enable timely review and adjudication of individual patient applications for high-cost therapies.
5. Work collaboratively with internal team members (clinical and technical staff) to continually revise drug funding policies based on current best practice.
6. In collaboration with the manager and Pharmacists, develop 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.
7. Develop and present materials for review and informational purposes using excellent written, verbal, and graphical communications skills, with ability to express complex concepts effectively.
8. Participate and lead, where appropriate, meetings with internal and external stakeholders to ensure consistency in work and identify opportunities for collaboration and/or improvement.
9. Identify technical needs, provide input into business requirements and work with colleagues to develop and test enhancements on electronic tools.
10. Support integration within Ontario Health departments on related work, as appropriate, and supports other initiatives with the program area.
11. Perform cross-functional tasks and other duties, as required.

Here is what you will need to be successful:

Education and Experience

1. An undergraduate degree in Health Studies, Health Systems, Health Services Research, Public Health, Laboratory Sciences/Studies, Genetics, Molecular Biology, or equivalent combination of education (e.g., diploma in pharmacy, genetics technology, nuclear medicine) and 5+ years’ experience in oncology and claims administrations.
2. 5+ years of direct experience working with eClaims, Ontario Health’s web-based claims adjudication and reimbursement system, is a strong asset.
3. 2+ years of direct experience working with and analyzing data using Ontario Health’s business intelligence tools, such as iPort, is an asset.
4. A strong understanding of the Ontario and Canadian health care landscape, specifically in oncology.
5. Experience working with health care providers and administrators.
6. Knowledge of public healthcare systems, public health policies, and the pan-Canadian review and consideration process for oncology and other high-cost therapies.
7. Expertise and experience in data analysis, literature searches, policy analysis, and business strategy, and the ability to translate information into a convincing written argument, summaries, briefs, or business case are considered assets.

Knowledge and Skills

1. Excellent organizational skills; responsible and highly motivated; must be able to manage multiple tasks, prioritize and effectively anticipate and respond to issues as they arise.
2. Excellent oral and written communication skills, including the ability to clearly and concisely articulate key messages that resonate with different audiences.
3. Detail-oriented and process-driven with a demonstrated ability to produce high quality work consistently and effectively.

Attributes

1. Creative and forward thinking, with a desire to learn and take on new opportunities.
2. Self-directed, with enthusiasm, initiative and demonstrated ability to work independently and collaboratively to achieve deadlines and high-quality deliverables.
3. Ability to work well under pressure in a fast-paced environment and exercise high caliber judgment.
4. Must be team-oriented, possess a positive attitude, and be committed to organizational health, culture, and values.
5. Excellent skills in explaining complex concepts in a manner which is simple and easy to understand.
6. Strong problem-solving skills and demonstrated ability to think critically and strategically.
7. Works collaboratively with others, supporting the needs and goals of the team, including taking on stretch assignments and/or providing coverage for colleagues.
8. Ability to define problems, find solutions and provide well-articulated recommendations.
9. Excellent oral and written communication skills, including the capacity to engage, and a demonstrated ability to build relationships with key stakeholders is required.

#OH-IND-REG
#LI-hybrid

Employment Type: Permanent Full time

Contract Length: N/A

Salary Band: Band 5

External Application Deadline Date: March 3, 2025

All applicants must be a resident of Ontario to be considered for roles at Ontario Health.

Ontario Health encourages applications from candidates who are First Nations, Métis, Inuit, and urban Indigenous; Francophone; members of Black and racialized groups; 2SLGBTQIA+ communities; trans and nonbinary individuals; and people living with disabilities.

Ontario Health is an accessible employer, and we offer accommodation in all aspects of employment, including the recruitment process. If you require a disability related accommodation in order to participate in the recruitment process, please email careers@ontariohealth.ca and a member of the team will connect with you within 48 hours.