Position profile: Program Consultant

Learn more about the position in the job posting.

  • Job Title: Program Consultant
  • Work Unit: Health Workforce Planning and Accountability Division, Provider Compensation and Strategic Partnerships Branch, Insured Services Delivery Unit
  • Ministry: Alberta Health
  • Competition Number: 1050204

Purpose

The Provider Compensation and Strategic Partnership Branch’s role within the Health Workforce Planning & Accountability Division of Alberta Health supports and implements overarching government directions for innovation in service delivery in the province of Alberta. This branch is comprised of three units: Alternative Compensation Delivery, Budget and Analytics and Insured Services. Each unit has a specific focus of activities to support the branch’s mandate.

The Insured Services Unit develops and implements a broad spectrum of programs and strategies to support overarching directions for innovation in service delivery to promote more efficient use of the health workforce, to provide better care to rural and under-serviced Albertans, and to facilitate communication among health care providers. Provides strategic leadership for the fee for service compensation models for physician and allied health providers under the Alberta Health Care Insurance Plan, including the content development and interpretation of the Schedule of Medical Benefits (SOMB), allied Schedules of Benefits (optometry, podiatry, podiatric surgery and oral maxillofacial surgery) and insured services in Alberta

The unit has two specialized teams, the Insured Services Delivery team and the Insured Services Design team which are responsible for the three program areas which include Schedule of Medical Benefits (SOMB), Allied Health Programs (including Oral Surgery, Podiatry, Podiatric Surgery and Optometry Schedules of Benefits). The unit is a lead within Alberta Health for system level strategic and policy direction related to physician and allied compensation

Reporting to the Manager of the Insured Services Delivery team, the primary role of the Program Consultant is to provide consultation and leadership to Alberta Health management and staff regarding the SOMB for the insured health services in Alberta. This position also analyzes expected utilization and budgetary impact to all changes to the SOMB which affect the over $4.2 billion Physician Services Budget.

This position is responsible for the ongoing research and analysis of the provincial health benefits program. This includes policy development, project and initiative management, program funding analysis, economic forecasting, claims analysis and investigation, client services, and medical research. This position requires a high level of decision making for recommendations on controversial issues with limited precedents. The position plays a major role in the department to achieve its core business objectives to sustain and improve the delivery of accessible, effective, quality health services and to support and promote the health system.

The incumbent is often one of the first points of contact regarding the provincial health benefits program and acts as a liaison to internal/external stakeholders by providing technical expertise on client services, branch operations, payment system, policy administration and legislative standards. The incumbent is responsible to ensure that new or revisions to the benefit program are consistent with business plans and government/departmental policies and mandate.

The incumbent is responsible to provide superior working relationships with external stakeholders in particular the Alberta Medical Association (AMA), Alberta Health Services (AHS) and the College of Physicians and Surgeons of Alberta (CPSA).

Responsibilities and Activities

Program Management

  • Supports initiatives and develops recommendations to complex problems where limited precedent exists. This may involve collaborative initiatives with key Alberta Health programs including Alternate Relationships Plans (ARP), Primary Care Networks (PCN), Compliance and Monitoring and Claims Management and with other Ministries. These activities require strong project management skills, conflict management and dispute resolution skills.
  • Collaborates with external (AMA, AHS and CPSA) and internal stakeholders (both intra and inter division) to support the successful implementation of changes to the SOMB.
  • Provides management with advanced policy and planning information related to proposed additions, deletions, amendments and interpretations relating to the four components of the SOMB: the General Rules, the Procedure List, the Price List and the Fee Modifier definitions.
  • Provides advice based on established processes and procedures within the framework of applicable legislation and government and departmental policies to a variety of stakeholders including; Government, medical professional governing bodies, AHS, Physician Compensation Committee (PCC), private sector billing agencies, individual stakeholders (physicians and Albertans), Allocation Working Group and the AMA.
  • The department has considerably high profile responsibility under the AMA Agreement working with the AMA and AHS on complex issues regarding physician compensation, allied health care provider compensation, and impacts on Alternate Relationship Programs and Primary Care Network and other key initiatives.
  • Participates in the strategic planning of the Branch to develop objectives and goals in support of the multiple programs including the SOMB, the 99.09 and Additional Compensation working group and the Allocation Working Group.

Division Leadership

  • Provides consultation to the In Province/Out of Province Claims Adjudication Supervisors and Adjudication staff regarding interpretation of the SOMB and communicates any SOMB changes
  • Provides leadership in the interpretation of policy, complex cases, and dispute resolution. These consultations often involve direct contact with medical practitioners, medical office managers, AMA Section heads, AMA staff, submitters and AHS managers/executive.
  • Provides knowledgeable advice and assistance to management by evaluating outcomes, proposals, and strategies to determine the feasibility and impact of changes to the benefit program(s).
  • Communicates with internal and external stakeholders, (AMA, College of Physicians and Surgeons of Alberta, internal health divisions, the general public, and other private and government agencies) to ensure the that the SOMB promotes the most appropriate, safe, efficient and cost effective delivery of physician services.
    Identifies factors/resources including the allocation of resources required to successfully complete projects.

Policy Development

  • Program and Project Policy Development
    • Prepares briefing notes, business cases, correspondence, and background materials to recommend action be taken by management, the Minister, AMA, AHS, and other medical governing bodies. All prepared materials are to be in a form and language that supports the department’s business plan goals and strategic planning.
    • Identify potential impacts on other business areas and stakeholders. Develop options and recommendations for courses of action which meet the short and long term goals and objectives of the Department/Ministry.
    • Provides briefings and reports on proposed or revised health service codes and general rules. Review new or updated medical procedures and make recommendations to the Team Lead, Managers, Director and working groups. Conduct research, literature reviews, historical data collection, statistical and financial analysis to identify policy consideration and to support department projects.
    • Assists Team Lead and management in researching, analyzing, planning and developing policies and procedures related to new medical technologies/procedures and initiatives where limited precedent exists for implementation in the SOMB by:
      • Consulting with key stakeholder groups (AMA, AHS, CPSA) medical practitioners, medical technology research institutes/consulting firms;
      • Preparing detailed program, policy and operational guidelines;
      • Preparing business cases;
      • Development of criteria and measures for monitoring and evaluation; and
      • Providing support and recommendations on new departmental initiatives relating to practitioner services.
      • Interprovincial comparisons for medical services in the other provinces
    • Represents the Branch and/or Division on key interdepartmental initiatives.
    • Provides information and clarification in public relations activities in the form of written and verbal communication for the purpose of educating external stakeholders, association members and internal staff regarding new recommendations and changes to the SOMB.

Evaluation and Statistical Analysis of Provincial Programs

  • Analyze statistical data regarding utilization of the SOMB and communicate findings with internal and external stakeholders.
  • Research, analyze and develop recommendations for new policies and procedures in order to improve service delivery and to remedy inefficiencies.
  • Provides recommendations for both short and long term goals of the Ministry. Supports physician and recipient resources planning by modifying and or implementing new fee codes into the SOMB. The Insured Services Delivery team:
    • Investigates different methods for linking complex information data bases for the purpose of, claims investigation, financial utilization analysis, physician/population medical utilization, medical procedure and health trends utilization and trends.
    • Applies statistical/economic techniques, research methodologies and theoretical models, prepares and analyzes cost and utilization data for internal and external stakeholders, presents recommendations, strategies, and outcome analyses to management, AMA, AHS and other external stakeholders.

Scope

The incumbent must work effectively and collaboratively with internal and external stakeholders to ensure existing or proposed policies are aligned with key stakeholders, legislation and key principles

This position impacts the results of the goals under the Alberta Medical Association Agreement (AMAA), assures fiduciary management of outcome-focused, quality, evidence-based health care delivery in Alberta. This position deals with policy issues and situations where often few, if any, precedents exist. This position contributes to the development of recommended policy initiatives working with AHS and AMA on complex issues regarding physician compensation as was previously under the former tri-lateral Master Agreement

This position influences the immediate and future direction of AHCIP operational process through policy documents, briefing notes, and business cases prepared for presentation to the Ministry and other Government members and may be under the scrutiny of the Official Opposition and general public.

Policy/Legislation research and development impacts the overall operation and effectiveness of the AHCIP and the level of coverage available to Albertans.

The position must provide leadership, support and work effectively and collaboratively with internal and external stakeholders to ensure policies either currently in place or proposed are considered aligned with key stakeholders, legislation and key principles;

  • Mandate of program offered by other government departments/agencies and the private sector (e.g. private insurers, the Workers' Compensation Board - Alberta)
  • Current legislation including the Canada Health Act, the Alberta Health Care Insurance Act, the Hospitals Act, Hospital Benefits Regulations, Oral Maxillofacial Facial Surgery Benefit Regulations, Extended Health Service Regulation, Claims for Benefits Regulation, Mental Health Act, Bylaws of the College of Physicians of Alberta, Freedom of Information (FOIP) Act, and the Health Information Act (HIA). This encompasses recommendations for future revision of legislation.
  • Broader departmental directions (Business Plans) and departmental and government wide criteria for reasonable access, effectiveness, affordability, and financial accountability.
  • Scientifically valid research methodology and data analysis as well as documented criteria for qualitative research to move towards an evidence-based service.
  • Broad consultation with interested stakeholders such as professional associations/colleges and other business areas in the department.

The incumbent must possess a sound understanding of the benefit program business administrative processes, legislative mandates, physician and public services mandates to assess concerns/issues and provide a response in order to devise workable and effective solutions.

The incumbent must have negotiation, mediation, consultation and effective communication skills to achieve consensus where differences of opinion exists between internal departments, service providers, and other key internal or external stakeholders.

Knowledge, Skills and Abilities

  • Reports to the Team Lead, with broad supervision received and in general allowing for considerable discretion regarding how work is planned and carried out.
  • Interacts with other Divisions within Alberta Health regarding program initiatives.
  • Researches, develops and prepares background papers, briefing notes and business cases for senior management and executive.
  • Interacts with key stakeholders in medical community, health discipline regulatory colleges, AMA, AHS, CPSA and other provincial health jurisdictions as required.
  • Requires directly related experience considered on the basis of 1 year of experience for 1 year of education; including negotiation skills, project management skills, change management skills and supervisory skills.
  • Key competencies/skills required include:
    • Drive for results, political savvy, customer focus, negotiation skills, business acumen, strategic agility, organizational agility, conflict management, quality of decision making, perspective, innovation management, dealing with ambiguity, motivating others, planning, process management, developing direct reports, presentation skills, creativity, project management and consultation skills.

Contacts

Internal:

  • Manager, Senior Manager, Executive Director, Professional Services and Health Benefits Division, Provider Compensation and Strategic Partnerships Branch, Insured Services Unit, Alternative Delivery Unit, Budget & Analytics Unit
  • Program Consultants, Policy Analyst, Manger, Team Lead: Health Insurance Programs Branch.
  • Manager, Senior Manager, Executive Director, Strategic Planning & Policy Development Division, Public Health and Compliance Division, Health Information Systems Division, Health Workforce Planning & Accountability Division, Financial and Corporate Services Division, Health Standards, Quality and Performance Division , Health Service Delivery Division and Senior Managers of Branches with each Division including Policy and Evaluation Services, Monitoring and Investigations, Health Analytics, Primary Care, Financial Planning, Corporate Services, and the Application and Business Support Team. FOIP Personnel and various personnel in the Deputy Minister’s Office. Purposes of contacts are related to project work, problem solving, information, dispute resolutions, and coordination.

External:

  • AMA, AHS, CPSA, Alberta Association of Optometrists, Alberta Dental Association and College, The College of Podiatric Physicians of Alberta and other various Colleges and Associations, Provincial and Territorial Health Plans, Health Canada, Alberta Practitioners, physician section heads, Albertans and other Ministries. Purposes of contacts are related to policy and program reviews, committee work, problem solving, information, conflict resolution, and coordination.

Supervision Exercised

  • N/A

The Government of Alberta is committed to a diverse and inclusive public service that reflects the population we serve to best meet the needs of Albertans. Consider joining a team where diversity, inclusion and innovation are valued and supported. For more information on diversity and inclusion, please visit the Diversity and Inclusion Policy.