1

Chart Utilization Review Jobs in Ontario (NOW HIRING)

Review changes and interventions to ensure risk management service goals are achieved on the ... Distribution S Curve Graph, Sensitivity Analysis Tornado Chart and Deep Dive Schedule Logic ...

Risk Analyst

Toronto, ON

CA$95K - CA$105K/yr

Review changes and interventions to ensure risk management service goals are achieved on the ... Distribution S Curve Graph, Sensitivity Analysis Tornado Chart and Deep Dive Schedule Logic ...

Chart Utilization Review information

What are the key skills and qualifications needed to thrive as a chart utilization review specialist, and why are they important?

To thrive as a Chart Utilization Review specialist, you need a background in healthcare, strong knowledge of medical terminology, and experience with patient care documentation, often supported by an RN or LPN license. Familiarity with utilization management software, electronic health records (EHR), and relevant certifications such as Certified Professional in Utilization Review (CPUR) are typically required. Attention to detail, analytical thinking, and effective communication are crucial soft skills for accurately reviewing charts and collaborating with healthcare providers. These abilities ensure compliance, optimize patient care, and support cost-effective healthcare delivery.

What is chart utilization review?

Chart Utilization Review is a process commonly used in healthcare settings to assess the necessity, appropriateness, and efficiency of medical services provided to patients. It involves reviewing patient charts and medical records to ensure that treatments and procedures are justified according to established guidelines and policies. This process helps in improving patient care, managing costs, and ensuring compliance with regulatory requirements. Utilization review professionals work closely with medical staff, insurance companies, and regulatory agencies to support quality and cost-effective care.

What are some common challenges faced by professionals in chart utilization review, and how can they be addressed?

Professionals in Chart Utilization Review often encounter challenges such as navigating incomplete or inconsistent medical documentation, staying current with ever-evolving healthcare regulations, and balancing productivity with accuracy. To address these challenges, it is important to maintain open communication with clinical staff, participate in ongoing training, and utilize robust electronic health record systems. Additionally, collaborating closely with interdisciplinary teams can help clarify documentation and ensure compliance with regulatory standards.

What is the difference between Chart Utilization Review vs Chart Review Specialist?

AspectChart Utilization ReviewChart Review Specialist
CredentialsTypically requires healthcare or insurance-related certificationsOften requires medical or coding certifications
Work EnvironmentHealthcare facilities, insurance companies, utilization management teamsMedical offices, insurance companies, coding firms
Employer & IndustryHospitals, insurance providers, healthcare organizationsMedical billing companies, insurance firms, healthcare providers
Primary FocusAssessing medical necessity and appropriateness of servicesReviewing medical records for coding accuracy and completeness

While both roles involve reviewing medical information, Chart Utilization Review focuses on evaluating the necessity of healthcare services, whereas Chart Review Specialists primarily verify medical documentation for coding and billing accuracy. Understanding these distinctions helps professionals choose the right career path or job search focus.

What are popular job titles related to Chart Utilization Review jobs in Ontario?

For Chart Utilization Review jobs in Ontario, the most frequently searched job titles are:

What job categories do people searching Chart Utilization Review jobs in Ontario look for?

The top searched job categories for Chart Utilization Review jobs in Ontario are:

Infographic showing various Chart Utilization Review job openings in Ontario as of August 2026, with employment types broken down into 1% As Needed, 75% Full Time, 22% Part Time, and 2% Contract. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution.

Coding Specialist - Clinical Utilization Services

Mackenzie Health

Richmond Hill, ON • On-site, Remote

Full-time

Re-posted 10 days ago


Job description

Job Description

The Coding Specialist, reporting to the Manager of Coding and Data Quality, and under leadership of coding lead/trainer will support the organization's new and growing clinical coding team through accurate and timely abstraction and coding of inpatient (DAD) and ED/Outpatient (NACRS) health information. Key components of the job include accurate and timely coding and abstraction of health information and assign ICD-10 diagnosis and intervention/procedure code as per CIHI coding standards and hospital guidelines to ensure timely CIHI submission, stay current in coding best practices as per changes in CIHI coding guidelines, perform tasks as assigned through coding improvement initiatives and projects, monitor CIHI monthly and quarterly submission error reports to ensure abstracts are corrected and resubmitted, active involvement in coding improvement initiatives and changes as directed by Mackenzie Health and ministry (CIHI), answer to coding-related inquiries as needed. Superb attention to detail is imperative to this role.

What must you have?

  • Graduate diploma of accredited Health Information Management Program.
  • Currently active and certified member in good standing with the Canadian Health Information Management Association (CHIMA). 

What else do you bring?

  • A minimum of one year experience with Discharge Abstract Database (DAD) and/or National Ambulatory Care Reporting System (NACRS) coding and abstraction. 
  • Ability to follow CIHI coding standards and hospital guidelines, abstract inpatient and/or outpatient charts in a timely manner to meet weekly/monthly submission goals.
  • Experience in reviewing patient charts within an electronic medical record system.
  • Basic knowledge of CIHI's acute inpatient and ambulatory case mix systems and weights (e.g. CMG/HIG/RIW, CACS/ACW). 
  • Demonstrated independent ability to prioritize, multi-task and work to tight timelines.
  • Self-starter and ability to work independently to provide leadership and support to peer staff. 
  • Attention to detail.
  • Excellent interpersonal, oral and written communication, and presentation skills.
  • Demonstrated commitment to continuing education. 
  • Proven attendance record.
  • Demonstrates understanding and complies with patient and staff safety policies and procedures that foster a safe and inclusive environment for all.
  • Ability to perform the essential duties of the job.
  • Effectively uses empathy in interactions with others and demonstrates behaviours consistent with Mackenzie Health's Commitment to Caring.
  • Models behaviour that is aligned with the values of Mackenzie Health - Excellence, Leadership and Empathy.
  • Commitment to providing an exceptional experience for staff and clients within a challenging and exciting health care environment.

Preferably, your profile also includes:

  • Experience working with Med2020 Winrecs abstracting software.
  • Experience with funding models (HSFR, HBAM, MOH QBPs, CCO QBPs). 
  • Knowledge in EPIC EMR chart review preferred and/or certification in Epic EMR systems. 
  • Knowledge and understanding of key health care performance measures (clinical, financial, utilization, efficiency) and balanced scorecards. 

*You may be required to work at any site of Mackenzie Health.

---

Mackenzie Health is an inclusive and equal opportunity employer committed to providing accommodations for applicants upon request at any stage of the recruitment process in accordance with the Accessibility for Ontarians with Disabilities Act (AODA) and the Ontario Human Rights Code.

Our hiring process does not involve the use of artificial intelligence (AI) to screen, assess or select applicants.

We thank all applicants for their interest; however, only those under consideration for an interview will be contacted.

---#MackenzieHealthCareers, #LI-JB1Employment Type: OTHER