Certified Ophthalmic Executive Candidate Application

Certified Ophthalmic Executive Candidate Application

Applicants must be individuals who are directly involved in the management of an ophthalmic organization that provides patient care. Applicants must demonstrate they have a minimum of two years of health care experience plus one or more years of ophthalmic management experience. Applicants must have demonstrated experience in each of the six exam domains: general ophthalmic knowledge, financial management, operations, information technology management, human resources, and risk management & regulatory compliance.

Name

First NameLast Name
Credentials/Designations
Date of Birth
Practice/Organization
E-mail
example@example.com
Business Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Business Phone Number

Country CodeArea CodePhone Number
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Home Phone Number

Country CodeArea CodePhone Number

Please fill in the below information based on your current practice. If not currently in a practice, type in N/A

Rows	Number
Number of Non-Physician FTE Staff Members
Number of non-physician part-time staff members?
Number of ophthalmologists?
Number of optometrists?
Years of ophthalmic management experience:

Are you a multi-specialty practice?
Do you have an ASC?
What elective services do you offer?

I certify that within the preceding five calendar years, I have a minimum of two years of health care administration experience plus one or more years in ophthalmic practice management.
Employment History

Please upload CV or resume
Cancelof
Current Job Description

.
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All COE Exam candidates must have demonstrated experience in each of the six exam domains referenced below and complete the checklist below. It is important to note that candidates do not need to have experience in each of the bulleted areas but must have some demonstrated experience in each of the six exam domains.
Domain I: Basic Ophthalmic Knowledge - 10%

Please check applicable experience
Subdomain 1: Basic ophthalmic terminology
Subdomain 2: Basic ophthalmic anatomy
Subdomain 3: Common ophthalmic instruments/equipment
Subdomain 4: Basic pharmacology
Subdomain 5: Common ophthalmic patient services
Subdomain 6: Standard ophthalmic practice triage
Domain II: Financial Management - 20%

Please check applicable experience
Task 1: Evaluate financial statements to assess the financial health of the practice. Knowledge of:
Task 2: Conduct feasibility analyses to assess return on investment. Knowledge of:
Task 3: Evaluate payer contract language and fee schedules to determine practice participation. Knowledge of:
Task 4: Evaluate vendor contracts to manage practice needs, overhead expenses, and revenues. Knowledge of:
Task 5: Establish accounting and financial controls to protect practice assets and minimize liability. Knowledge of:
Domain III: Operations - 22%

Please check applicable experience
Task 1: Coordinate the development, implementation, and monitoring of the strategic plan to maximize practice potential. Knowledge of:
Task 2: Develop and monitor management reports to evaluate the operational efficiency of the practice. Knowledge of:
Task 3: Develop and implement operational directives, policies, procedures, and training protocols to optimize practice performance and ensure quality of care. Knowledge of:
Task 4: Manage practice real estate, facilities, equipment, and supplies to provide safe, efficient, and high-quality care. Knowledge of:
Task 5: Develop and manage ancillary service lines (optical, Ambulatory Surgery Center, refractive, real estate, elective, etc.) to align with the strategic plan. Knowledge of:
Task 6: Determine staffing needs to ensure practice productivity and efficiency. Knowledge of:
Task 7: Develop and implement marketing plans to support and enhance business lines. Knowledge of:
Domain IV: Information Technology Management - 12%

Please check applicable experience
Task 1: Implement and manage information systems to meet technology needs and comply with regulatory requirements and/or guidelines. Knowledge of:
Task 2: Perform information technology risk analyses to ensure the confidentiality, integrity, and availability of practice data. Knowledge of:
Domain V: Human Resources - 18%

Please check applicable experience
Task 1: Develop and modify personnel policies to establish expectations for professional conduct. Knowledge of:
Task 2: Educate, coach, reward, and/or discipline staff to ensure compliance with personnel policies. Knowledge of:
Task 3: Develop and oversee programs to provide fair and competitive compensation packages. Knowledge of:
Task 4: Recruit, retain, and terminate staff to meet organizational staffing needs. Knowledge of:
Task 5: Conduct evaluations to enhance employee and practice performance. Knowledge of:
Domain VI: Risk Management & Regulatory Compliance - 16%

Please check applicable experience
Task 1: Develop programs to ensure compliance with governmental regulations and guidelines. Knowledge of:
Task 2: Mitigate legal liability (regulatory and negligence) to minimize financial losses. Knowledge of:

Do you have a condition that requires special accommodations for testing?

Select

COE Application Member

COE Application for Member

$300.00 Quantity

COE Application Non-member

COE Application for Non-member

$600.00 Quantity

Total

Debit or Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year

I hereby attest the above information is true and accurate to the best of my knowledge.
Please verify that you are human
Should be Empty:

Certified Ophthalmic Executive Candidate Application

Domain I: Basic Ophthalmic Knowledge - 10%

Domain II: Financial Management - 20%

Domain III: Operations - 22%

Domain IV: Information Technology Management - 12%

Domain V: Human Resources - 18%

Domain VI: Risk Management & Regulatory Compliance - 16%

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