Medical consultants: NS Department of Health and Wellness

The Department of Health and Wellness (DHW) is seeking the services of two physician medical consultants to provide expert advice on the development of a range of policies and initiatives that impact physicians, and to serve as a departmental expert on provincial health policy, clinical, benefit eligibility and physician issues, including compensation and audits.

The Department of Health and Wellness administers a number of insured health programs, including physician services, pharmacare, children's oral health program, and other extended health benefits programs. The physician consultants will also provide support and advice across the Department and directly to the Deputy Minister and Minister, as required.

The physician consultants will fulfill several key roles including:

• Providing broad clinical expertise to support policy development within DHW, across all program areas as needed.
• Review of requests for new/revised physician billing fees.
• Advising on out-of-province or out-of-country referrals to determine medical necessity and eligibility.
• Provide medical knowledge and expertise in billing practices, tariff, and clinical procedures.
• Representing DHW on various committees and providing advice to negotiating teams.
• Support the implementation of the Physician Services Agreement through various joint committees with Doctors Nova Scotia.

Primary Accountabilities

The medical consultants provide expert advice to DHW in a variety of settings all under the direction of the Department, including the Minister, Deputy Minister, and Senior Executive Director(s) Physician Services, Benefits Eligibility and Clinical. The medical consultant’s services will include, at the Department’s direction, the following:

• Advising on the development of policies and guidelines and recommending the insurance of new services that are medically necessary.
• Advising on the application of policies and guidelines and, where required, on requests made for non-standard approvals in exceptional circumstances.
• Advising, representing, and acting for the Department in physician payment audits, reviews, and appeals, including dispute resolution processes, as agent for and under the direction of the Department.
• Providing direction to the physician consultant(s) at the MSI administrator (currently Medavie Blue Cross) to review cases where the application of policy does not provide a clear answer with regard to the insurability of new types of cases or procedures.
• Advising on requests for new fees and reviewing the fees paid for similar services across Canada. Advice is provided regarding the necessity for new or amended fee codes, including recommendations for implementation of interim fees and final fees (tariff) for the Fee Schedule.
• Representing DHW on various committees and task forces dealing with insured medical services, MSI policy and technology assessment.
• Providing advice to DHW in preparation for the renewal of the Physician Agreement, the Academic Funding Plan Contract, and other contracts for the provision of insured medical services.
•  Advising as needed on provincial standards and provincial initiatives that directly impact upon physicians to ensure that they reflect physician input. For this purpose, the medical consultants will develop and maintain positive relationships with physician groups including, but not limited to, the health authorities, Medavie, College of Physicians & Surgeons, Doctors Nova Scotia, Dalhousie Faculty of Medicine, and Maritime Resident Doctors.

Qualifications and Experience

The successful Physician Consultant will have:

• Membership/Fellowship in the Royal College of Physicians and Surgeons in a medical or surgical specialty or College of Family Physicians.
• Minimum 15 years of experience as a physician in a clinical setting.
• Demonstrable knowledge of Canadian and Nova Scotia health systems, clinical activity reporting, physician billing practices, tariffs, and clinical procedures.
• Knowledge and understanding of physician billing practices, tariff, and clinical procedures, especially as they relate to the Nova Scotia Medical Services Insurance system.
• Understanding of the Nova Scotia health care delivery system.
• Knowledge of the NS physician manual, fee structure, legislation, and regulation.
• Experience and training in health administration, policy development and analysis.
• Experience in clinical audit and/or economic analysis.

DHW Contract Position

The Medical Consultants will work up to 30 hours per week over 46 weeks. The Medical Consultants will be remunerated through a personal services contract for one year which may be extended by agreement of the parties and will be paid an hourly rate based on the specialist or family physician sessional rate.

Interested candidates are asked to email their cover letter and CV to:

Angela Purcell
Senior Executive Director, Physician Services
Nova Scotia Department of Health and Wellness