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Insurance Utilization Review Jobs in Ontario (NOW HIRING)

ST JOHNS HEALTH

$22.68 - $27/hr

ID, insurance, consent, physician order, name change information, advance directives, etc. · ... Utilization Review for the appropriate status of patients as well as collecting any legally ...

HOME CAREGIVERS PARTNERSHIP LLC

Health, dental, vision, and life insurance. 401(k) savings plan. PTO. Responsibilities: - Utilizes ... Participates in utilization review of medical records as assigned. * Gives total patient care as ...

HOME CAREGIVERS PARTNERSHIP LLC

Health, dental, vision, and life insurance. 401(k) savings plan. PTO. Responsibilities: - Utilizes ... Participates in utilization review of medical records as assigned. * Gives total patient care as ...

Ryder

Manager - Owner Operator Network

London, ON · On-site

CA$80K - CA$85K/yr

... reviews and complete carrier audits Equipment & Asset Management Oversee truck onboarding process, including licensing, insurance, including utilization tracking, compliance requirements, and ...

Federal Signal

Rentals Fleet Manager

Innisfil, ON

CA$95K/yr

Review, assess, and approve rental fleet maintenance estimates and invoices * Provide technical ... Support fleet readiness planning to meet scheduling, utilization, and forecasting requirements ...

Process Group - Industrial Service Solutions

Be Seen First

Administrative Operations Coordinator

Cambridge, ON · On-site

CA$40K - CA$70K/yr

... control, utilization and charge out, repair and maintenance expenses and return on investment ... review major suppliers regularly to ensure service and pricing is competitive. Establish the ...

People Corporation

Account Executive

Cambridge, ON · On-site

... 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 ...

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Insurance Utilization Review information

What is an insurance utilization review?

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 the key skills and qualifications needed to thrive in insurance utilization review?

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 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.

How do I get into an insurance utilization review?

To become an insurance utilization review specialist, candidates typically need a background in healthcare, nursing, or a related field, along with knowledge of insurance policies and medical terminology. Certification such as the Certified Professional in Healthcare Quality (CPHQ) or similar credentials can enhance job prospects. Relevant skills include attention to detail, analytical thinking, and familiarity with medical records and insurance software systems.

Is insurance utilization review a stressful job?

Insurance utilization review can be stressful due to the need for accuracy, attention to detail, and meeting strict deadlines. Reviewers often handle complex cases and must balance policy guidelines with patient needs, which can contribute to job pressure. However, the level of stress varies depending on workload, work environment, and individual coping skills.

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:

Insurance Utilization Review jobs near you
Infographic showing various Insurance Utilization Review job openings in Ontario as of August 2026, with employment types broken down into 1% As Needed, 72% Full Time, 21% Part Time, and 6% Contract. Highlights an 85% Physical, 1% Hybrid, and 14% Remote job distribution.

Patient Admissions Coordinator

ST JOHNS HEALTH

On-site

$22.68 - $27/hr

Full-time

This job post has expired today. Applications are no longer accepted.

Job description

JOB SUMMARY
Embraces the vision of Patient Financial Services: "To provide highly regarded and desirable Patient Financial
Services that are caring, honorable, and innovative." Under the direction of the Patient Financial Services Supervisor,
the Patient Admissions Coordinator maintains proficient emergency registration as well as various inpatient and
outpatient registration. Engages in efficient processing of assigned tasks and projects while providing an exceptional
level of customer service for all hospital customers. Provides multiple patient financial services in the form of: timely
and accurate patient registrations, existing patient system demographic, insurance data updates, basic payment
collections, and engagement in quality assurance and process accuracy.
 
ESSENTIAL FUNCTIONS
Registration
· Registers patients in a timely and effective manner, while maintaining a high level of attention to detail with data
entry. Audits visits for completeness. Ensures that paperwork and documentation are collected when appropriate; i.e.
ID, insurance, consent, physician order, name change information, advance directives, etc.
· Identifies compliance of orders, including CPT and ICD-10 codes, along with other requirements per policy. If an
order is identified as incomplete, contacts the physician's office to obtain the necessary information.
· Protects and ensures the confidentiality of patient information, especially when delivering paperwork to the
appropriate department.
· Follows federal, state, and any other legal guidelines such as EMTALA or HIPAA with regards to job functions.
· Coordinates with internal departments such as Utilization Review for the appropriate status of patients as well as
collecting any legally required documentation.
 
Customer Service and Communication
· Meets the needs of all customers to enhance communication, way-finding, and access to available services at St.
John's Health and affiliated facilities.
· Able to field questions and/or issues to the appropriate person or department. Communicates effectively, and
presents a confident and friendly demeanor with all customers internally and externally.
· Performs duties according to the Scope of Service for Patient Access.
· Continuously contributes to an extraordinary patient and customer experience throughout St. John's Health.
· Comfortable providing registration service for patients in pain, distress, or a traumatic situations; whether it be at the
main emergency entrance of bedside.
 
Financial Services
· Collect patient financial obligations such as copays or estimated liability at time of discharge/check out.
· Applies collected amounts to the appropriate patient account, ensures cash is given to the appropriate staff member
for bank deposit, and delivers receipts to the Cash Posting Team for reconciliation.
· Connects the patient with Financial Navigation for more complex financial discussions.
· Collect appropriate forms and patient signatures in relation to financial obligations, i.e. Patient Responsibility
Waiver, Important Message from Medicare/TRICARE, etc...
 
Teamwork
· Represents, facilitates, and elevates team success within Patient Financial Services, and St. John's Health as a
whole.
· Assists Supervisor or Manager with various special projects as needed.
· Collaborates with other departments such as Utilization Review, Case Management, Nursing Units, Patient
Assistance, etc., as needed, when additional information from the patient is necessary.
· Is clocked in and ready to take patients or carry out job responsibilities right at the start of shift. General expectation
is to be clocking in 5 minutes prior to shift.
 
Problem Solving and Improvement Activities
· Autonomously applies sound judgment to solve operational problems, appropriately following up with team
members and leadership to address. Participates in the launch, development, implementation, and control of
improvement projects.
· Adheres to and practices in St. John's Health Corporate Compliance Program, and participates in Performance
Improvement activities.
· Seeks and implements improvement projects directly related to patient admission functions.
 
Communication
· Support and backup the general switchboard function for St. John's Health. Call inbound to the hospital general line
should be handled in a professional and courteous manner and connected promptly with requested connection.
· Respond appropriately to all applicable emergency response situations (aka Code scenarios) such as local
disasters, bomb threats, fires, etc.
· Monitor alarm panel and respond appropriately and quickly to resolve. This may involve overhead paging, calling
appropriate staff or local emergency services.
 
JOB REQUIREMENTS
Minimum Education
Required: High School Degree or GED equivalent.
Preferred: Associates or Bachelors Degree, medical terminology certification or proven knowledge of medical terminology, other
relevant professional certifications.
 
Minimum Work Experience
Required: Must be able to read, write and speak English fluently. Prior Front Desk or Business Office experience. One year or
more of strong customer service experience.
Preferred: Prior healthcare experience.
 
FUNCTIONAL DEMANDS
Working Conditions
Varying shifts, primarily on weekends, within a 24/7 department. On-site hospital emergency access area position.
Frequent interruptions and stressful situations. Contact with patients, co-workers and community members under a
variety of circumstances. Must be on-site at the St. John's Health campus or other facilities to fulfill the responsibilities
of this role.
 
Physical Requirements
60 to 80% of day sitting and computer use. Medium phone usage. Intermittent standing and walking. Ability to
lift/push/pull 20 pounds.
 
Direct Reports: None
 
Reports to: Sr. Business Relationship Manager
 
Internal & External Contacts: Patients, patient's family members, members of the community, physicians, nurses, St. John's Health staff, Fire/EMS,
Law Enforcement Officers and vendors.
 
LEADERSHIP CAPABILITIES
Attention to Detail
• Completes tasks in a way that ensures there are no errors
• Methodically and patiently reviews work to identify any mistakes or discrepancies
• Creates and stores documentation in a way that is thorough and easy to access
 
Priority Setting
• Spends his/her time and the time of others on what's important
• Quickly zeros in on the critical few and puts the trivial many aside
 
Time Management
• Uses his/her time effectively and efficiently
• Concentrates his/her efforts on the more important priorities
• Gets more done in less time than others
 
Composure
• Avoids becoming defensive or irritated when times are tough
• Maintains balance when the unexpected happens
 
Interpersonal Skills
• Relates well to all kinds of people, up, down and sideways, inside and outside the organization
• Builds appropriate rapport
• Uses diplomacy and tact
 
Organizing
• Can coordinate multiple activities and resources at once to accomplish a goal
• Arranges information and files in a useful manner

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