This is a managerial position, which has departmental-wide responsibility for activities and direction of the Operations Department, which includes the NHIP Emergency Overseas Treatment Programme. It provides technical leadership to the Case Management and Claims Management teams.

POSITION SUMMARY:

This is a managerial position, which has departmental-wide responsibility for activities and direction of the Operations Department, which includes the NHIP Emergency Overseas Treatment Programme. It provides technical leadership to the Case Management and Claims Management teams. The Medical Officer formulates policies and procedures to enhance the impact of the department; monitors patients overseas to assess their progress and report to the Chief Executive Officer; verify the eligibility of all claims, ensure staff are properly supervised and trained, customer concerns addressed; and  appropriate, cost-efficient health care services with best medical practices in place are provided to NHIP Beneficiaries.

MAIN DUTIES AND RESPONSIBILITIES

• • Manages the medical aspects of the NHIP Emergency Overseas Treatment Programme; 
  • Manages all aspects of the Operations Department, inclusive of all staff assigned to the department.
  • Manages and develops the Operations Department’s Budget with the view of ensuring that the Department’s expenditure remains within or below the budgeted ranges. 
  • Develops policies, procedures, standards, and controls for effective management of the Operations Department.
  • Ensures statistics are collected from InterHealth Canada Limited (TCI Hospital) and the private providers as required by management and for actuarial and other health-related assessments. 
  • Liaises with the NIB to identify number of employment injury and occupational disease cases.
  • Enforces appropriate cost-reduction strategies and recommends initiatives in the management of patient’s care;
  • Prepares Quarterly Performance Reports and Trend Analysis. 
  • Recommends and monitors systems and procedures to facilitate achievement of objectives within the area of responsibility.
  • Verifies and signs-off on overseas provider claims in order to ensure veracity of claims as well as conducts value for money audits.
  • Advises on the adjudication of claims by beneficiaries in special circumstances, outside the scope of usual and customary benefits, including overseas claims.
  • Makes recommendations to the Board on policy decisions, such as but not limited to reimbursement and accreditation standards in line with the Health Practitioners Board or other authorized Agency.
  • Conducts sample surveys of health care providers and facilities to derive baseline data on the availability, quality of services offered, the capacity and readiness to meet the demands of the NHIB.
  • Coordinates activities and provides advice to the NHIB team charged with the specification and costing of the service benefit package and in the development of provider payment systems.
  • Convenes and takes the lead in meetings and other mechanisms aimed at defining criteria for inclusion in the NHIB Provider Network, as well as developing norms and protocols for quality assurance utilization reviews, access to overseas care, and modifications (inclusion and exclusion) of items in the benefit package.
  • Collaborates with other members on the NHIB team in the design and implementation of activities related to accreditation of health providers.
  • Collaborates with other members of the NHIB team in defining and developing contractual agreements with local and overseas providers for services within the benefit package.
  • Assists in the development of detailed terms of reference and procedures for the activities of the NHIB Medical Review Committee.
  • May perform other duties as assigned by the immediate supervisor or any other person authorized to give instructions or assignments. 
  • Any other duties deemed appropriate and consistent with the position, professional qualification and skill set as directed by the Chief Executive Officer.

   

  QUALIFICATIONS AND EXPERIENCE:

  • Medical Doctor with at least 7 years’ experience; full time practitioner in primary care and hospital settings with the necessary competencies to effectively respond to the challenges of the job.
  • Graduate Degree in Business or related field.
  • Business Management Experience
  • Knowledge of the NHIB Ordinance and Regulations
  • Current (Good Standing) Registration with TCI Health Practitioners Board and other professional/regulatory body as appropriate.
  • Experience with health insurance operations such as member of a medical review panel will be an asset.

   

  Deadline for submission is 28 July 2023