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Insurance Utilization Review Jobs in Ontario (NOW HIRING)

Director of Finance

Toronto, ON · On-site

$150 - $160/hr

Manage corporate insurance programs and ensure appropriate levels of risk protection. * Lead the ... Deep understanding of utilization, revenue recognition, and margin drivers within a professional ...

Director of Finance

Toronto, ON · Hybrid

CA$150K - CA$160K/yr

Manage corporate insurance programs and ensure appropriate levels of risk protection. Lead the ... Deep understanding of utilization, revenue recognition, and margin drivers within a professional ...

... the utilization among the various benefit levels, * Ensure that the funding arrangement/pricing ... Review renewal results and negotiate with insurance carriers as appropriate, * Work closely with ...

... utilization of AWS/Azure cloud services. * Performance Optimization: Proactively identify and ... Conduct code reviews and provide technical guidance to team members to ensure best practices.

Senior Benefits Consultant

Toronto, ON · On-site

CA$100K - CA$120K/yr

... insured, selffunded, ASO, and flexible benefits plans. * Lead the annual renewal process endtoend ... Analyze claims, utilization, and demographic data to identify trends, assess financial impact, and ...

Great health, dental, and vision insurance * DPSP plan that includes company dollar-for-dollar ... Reviewing SiteDocs Monthly Vehicle Audit submissions and defect close-outs; escalating non ...

Great health, dental, and vision insurance * DPSP plan that includes company dollar-for-dollar ... Reviewing SiteDocs Monthly Vehicle Audit submissions and defect close-outs; escalating non ...

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Insurance Utilization Review information

What are the most common challenges faced by Insurance Utilization Review professionals?

One common challenge in Insurance Utilization Review is balancing the need for cost-effective care with the clinical needs of patients, which often requires careful analysis and decision-making. Professionals in this role frequently navigate complex medical records, strict policy guidelines, and collaborate with healthcare providers who may advocate strongly for particular treatments. Managing challenging conversations while maintaining professionalism and ensuring timely determinations are also a regular part of the role. Developing expertise in these areas can make the job both demanding and rewarding, while building a strong foundation for career growth within healthcare administration.

What are the key skills and qualifications needed to thrive in the Insurance Utilization Review position, and why are they important?

To thrive in Insurance Utilization Review, you generally need a strong background in healthcare or nursing, an understanding of medical terminology, and analytical thinking skills, often supported by an RN license or relevant clinical experience. Familiarity with utilization management software, coding systems like ICD-10, and knowledge of regulatory requirements (such as Medicare or Medicaid) are important. Strong communication, attention to detail, and problem-solving abilities help professionals excel when interacting with providers and insurers. These skills are essential to ensure appropriate care is authorized while maintaining regulatory compliance and cost-effectiveness.

What is an Insurance Utilization Review job?

An Insurance Utilization Review job involves evaluating medical treatments and services to determine if they are necessary, appropriate, and covered by a patient's insurance plan. Professionals in this role review medical records, treatment plans, and insurance policies to ensure compliance with guidelines and cost-effectiveness. They work closely with healthcare providers, insurance companies, and patients to facilitate approvals or appeals. The goal is to balance quality patient care with cost containment in the healthcare system.

What are popular job titles related to Insurance Utilization Review jobs in Ontario? For Insurance Utilization Review jobs in Ontario, the most frequently searched job titles are:
What job categories do people searching Insurance Utilization Review jobs in Ontario look for? The top searched job categories for Insurance Utilization Review jobs in Ontario are:
Infographic showing various Insurance Utilization Review job openings in Ontario as of July 2026, with employment types broken down into 1% As Needed, 71% Full Time, 23% Part Time, and 5% Contract. Highlights an 91% Physical, 1% Hybrid, and 8% Remote job distribution.

Regional Director, Operations - Ontario

Verve Senior Living

Toronto, ON • On-site

$110 - $150/hr

Other

Posted 11 days ago


Job description

At Verve Senior Living, we’re driven by a shared commitment to creating meaningful experiences for the older adults we serve. Our teams bring passion, creativity, and heart to everything they do, and it shows in our culture of collaboration, innovation, and continuous improvement. We’re proud to have received Canada's Best Managed Award in 2023, 2024, 2025, & 2026 reflecting our dedication to service, leadership, and care. What truly sets us apart are the people who choose to build their careers here. Whether you're supporting our residences or contributing within our corporate community, your work plays an important role in helping seniors live longer, better and you’ll be supported by a team that believes in growing together, celebrating success, and having fun along the way. If you’re looking for a place where your work has real impact, and where you can thrive personally and professionally, we’d love to meet you!

ACCOUNTABILITY OBJECTIVE

In collaboration with the Vice President, Operations - Ontario, provides leadership and support to General Managers to promote the attainment of corporate objectives and providing quality care and service through the implementation of Verve Quality Improvement (VQI) program.

BACKGROUND/QUALIFICATIONS
  • At least 5 years of managerial experience particularly in the field of the Retirement Home industry.
  • University degree or equivalent required.
  • Demonstrated business acumen including financial management.
  • Demonstrated leadership, conceptual, influencing and communicating skills.
  • Excellent English communication skills necessary.
  • Must possess a current, valid, driver's license and be willing to travel using own personal vehicle, with some overnight travel required.
KEY RESPONSIBILITIES
  • Introduces and ensures implementation of all Verve Quality Improvement (VQI) activities.
  • Ensures effective utilization and control of financial resources by:
    • Ensuring through the budget process short- and long-range fiscal planning.
    • Ensuring provision of appropriate financial information, direction, and timely reporting to General Managers to enable them to administer and control their respective budgets.
    • Reviewing home financial reports on a regular basis and working closely with controller and General Managers in analyzing variances to budget and implementing corrective actions as necessary.
  • Provides guidance to General Managers in planning, formulating, and implementing strategies, policies and objectives that support the provision of quality care.
  • Assists General Managers through the goal setting and performance review process in the identification of collective and individual goals and developmental needs. Implements programs to meet those needs utilizing corporate and/or external resources as necessary.
  • Promotes research, testing and evaluation of new approaches to care, and maintains effective ongoing care evaluation programs.
  • Acts as resource/consultant on matters of nursing care, finances, facility start-ups (including furnishings), purchasing, information systems, and continuous quality improvement for the homes.
  • Provides guidance and support for the development, implementation and maintenance of proactive, quality systems related to employee relations programs.
  • Assists in seeking growth in the Ontario Region through acquisition of new management contracts.
  • Develops, researches, and keeps current of new and innovative care, service and marketing methods to increase occupancy and ensure innovative provision of services to seniors.
  • Communicates effectively and works cooperatively with all team members and owners to ensure work is effectively completed, a good working atmosphere is provided for fellow employees, and cooperative ventures are effectively developed and implemented.
  • Ensures effective utilization and control of financial resources through effective budgeting, ensuring provision and monitoring of appropriate financial information, and reviewing financial reports and corrective actions as necessary.
  • Chairs regional committees as necessary.
  • Complies with the Occupational Health and Safety Act, Workplace Safety and Insurance Act, and Workplace Hazardous Materials Information System, as well as all other applicable legislation.
  • Completes all other duties as assigned by the Vice President, Operations - Ontario, which may include involvement in special projects, analysis, etc.

All offers of employment are subject to a Criminal Background Check. We thank all those who apply; however only candidates under consideration will be contacted.

Verve Senior Living is an inclusive, equitable and accessible workplace. We are dedicated to building a team that reflects the diversity of the residents and communities in which we live and serve. If you require accommodation for any portion of the recruitment and hiring process, please let us know.

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