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Remote Utilization Review Manager Jobs in Kitchener Waterloo, ON

Work with colleagues and managers to proactively manage a superior technology solution for our ... reviews & documentation, requirements elicitation, allowing the project team to gain a ...

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This is a fully remote position where you'll work with pre-qualified clients, help Canadian ... Meet virtually with clients via Zoom to review their insurance and benefit options. * Build ...

Review tax returns and other tax work prepared by staff. * Manage engagement financials including ... Remote working arrangements. Giving back to the community: * Three paid days off to volunteer;

We're a remote-first company with a collaboration hub in downtown Kitchener, and we're growing ... account management model: which accounts get true quarterly business reviews, which run on ...

Remote (Candidate must reside in Canada) Hiring Range : $100,000 - $115,000 About Us: Friendlier is ... Conduct regular code reviews and testing to maintain high standards * Introduce AI tooling to ...

Remote (Candidate must reside in Canada) Hiring Range: $100,000 - $115,000 About Us: Friendlier is ... Conduct regular code reviews and testing to maintain high standards * Introduce AI tooling to ...

Remote (Candidate must reside in Canada) Hiring Range: $100,000 - $115,000 About Us: Friendlier is ... Conduct regular code reviews and testing to maintain high standards * Introduce AI tooling to ...

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Remote Utilization Review Manager information

What are some common challenges faced by a Remote Utilization Review Manager, and how can they be addressed?

A Remote Utilization Review Manager often encounters challenges such as maintaining effective communication with clinical teams, ensuring timely and accurate reviews, and staying updated with changing regulations and payer requirements. To address these, it's important to leverage secure collaborative platforms, establish clear workflows, and participate in ongoing training. Building strong relationships with team members and regularly reviewing protocols also help in overcoming remote work hurdles and ensuring compliance and efficiency.

What is the difference between Remote Utilization Review Manager vs Remote Utilization Review Nurse?

AspectRemote Utilization Review ManagerRemote Utilization Review Nurse
CredentialsTypically requires a nursing license, certifications like URAC or AAPC, and management experienceLicensed Registered Nurse (RN) with utilization review certification often preferred
Work EnvironmentOversees review teams, manages processes, and ensures compliance remotelyPerforms case reviews, assesses medical necessity, and documents findings remotely
Employer & Industry UsageHealth insurance companies, third-party administrators, healthcare organizations

The Remote Utilization Review Manager focuses on overseeing review teams and managing processes, while the Remote Utilization Review Nurse conducts case assessments and medical necessity reviews. Both roles require nursing credentials and are integral to healthcare utilization management, but differ in responsibilities and leadership levels.

What is a Remote Utilization Review Manager?

A Remote Utilization Review Manager is a healthcare professional responsible for overseeing the review of medical services and determining the necessity, appropriateness, and efficiency of those services from a remote location. They ensure that healthcare providers comply with guidelines and that patients receive appropriate care without unnecessary procedures. These managers work with clinical teams, insurance companies, and regulatory agencies to optimize patient outcomes and manage healthcare costs. Working remotely allows them to perform these duties using digital health records and telecommunication tools.

What are the key skills and qualifications needed to thrive as a Remote Utilization Review Manager, and why are they important?

To thrive as a Remote Utilization Review Manager, you need expertise in healthcare management, case review, and regulatory compliance, typically supported by a nursing degree (RN or BSN) and relevant certifications such as CCM or URAC. Familiarity with utilization management software, electronic health records (EHRs), and payer systems is essential. Strong analytical thinking, attention to detail, and excellent communication skills help navigate complex cases and collaborate with clinical teams and insurers. These skills ensure effective resource utilization, regulatory adherence, and optimal patient outcomes in a remote healthcare environment.
What are popular job titles related to Remote Utilization Review Manager jobs in Kitchener Waterloo, ON? For Remote Utilization Review Manager jobs in Kitchener Waterloo, ON, the most frequently searched job titles are:
What job categories do people searching Remote Utilization Review Manager jobs in Kitchener Waterloo, ON look for? The top searched job categories for Remote Utilization Review Manager jobs in Kitchener Waterloo, ON are:

(Remote) Application Consultant

Cayenta

Guelph, ON โ€ข Remote

Full-time

Medical, Dental, Vision, Retirement, PTO

Posted 21 days ago


Job description

Cayenta, a division of Harris; is seeking an Application Consultant who is passionate about providing segregated IT transformation for our clients.

Our Client Services team has an exciting opportunity for driven individuals with accounting and work management experience. It is important for this individual to evolve into a conduit between Operations, R&D, and our clients, working cross-functionally to become a product expert and a client process advisor.

The Application Consultant role is project driven and will support a wide array of services for our Install Base customers.

This remote role welcomes candidates anywhere in Canada and the US. Travel is required as needed, approximately 25%. Candidates must hold a current, valid passport and be legally eligible to travel internationally. This includes either passport based visa exemption or possession of any required travel visas for entry into Canada, the United States, and the Caribbean.

Salary: 60K - 85K CAD

AI & Innovation Mindset

We are committed to leveraging emerging technologies to improve how we work, serve our customers, and drive business outcomes. The successful candidate will demonstrate curiosity and a willingness to actively adopt and leverage AI tools to improve workflows, solve problems, and increase efficiency. Candidates should be comfortable using AI enabled technologies, including copilots, chat based AI assistants, and automation tools, as part of their everyday work while maintaining appropriate judgment, security, and compliance standards.


What your impact will be:

  • Work with colleagues and managers to proactively manage a superior technology solution for our clients.
  • Provide support to existing and new clients by leading customers through our processes, communicating with those involved to ensure that solution is completed and any issues are resolved so the client can be successfully utilizing the product. Train users in the system set up, administration and maintenance.
  • Provide Business analysis, through gap analysis, root cause analysis, facilitation of business process reviews & documentation, requirements elicitation, allowing the project team to gain a comprehensive understanding of the client's needs in order to overcome barriers and achieve the organizational goals of the client. Understand clients' business processes and configure applications based on business needs and accepted best practices.
  • Own the user acceptance testing and change management process by ensuring stakeholder satisfaction with the outcome of the project through client testing and training.
  • Create user documentation when required and the complete handover documentation to assist support staff in providing quality customer care.
  • Build our clients' capabilities; encouraging them to achieve success beyond their expectations by identifying opportunities for recommending additional products and services that fit the needs of our clients.
  • Support Project Managers in managing engagement contracts, identifying & escalating bottlenecks, and project progress updates.
  • Efficient delivery of services that ensure key project milestones are met on a timely manner, in addition to exceptional utilization of assigned resources.
  • Be a leader in providing subject matter expertise to R&D and other operational groups, by understanding market trends of client needs and business practices to ensure the success of our product, incorporating industry best practices in order to maintain strengthen our position within the market.

What we are looking for:

  • Experience in Business Analysis, working on ERP software specifically accounting and work management (or relevant education).
  • Exemplary customer service skills and willing to be on a client facing role.
  • Problem-solving skills with the knowledge to support business leaders.
  • Proficient in Office 365.
  • Willingness to travel up to 25%.


What would make you stand out:

  • Bachelor's degree in Information Systems, Accounting or combination of Information technology and Accounting/Finance/Payroll from an accredited institution.
  • Knowledge of WMS and Asset Management.
  • Knowledge of Accounting and Financial Systems.
  • Working Knowledge of SQL.

What we can offer:

  • 3 weeks' vacation and 5 personal days
  • Comprehensive Medical, Dental, and Vision benefits starting from your first day of employment
  • Employee stock ownership and RRSP/401k matching programs
  • Lifestyle rewards
  • Remote work and more!

About Cayenta:

Cayenta is a leading provider of enterprise resource management solutions in the local government, utility and financial industries. Cayenta's products, services and customer relationships provide the foundation for continued innovation and growth.

About Harris:

Harris is a leading provider of mission critical software to the public sector in North America. As a wholly owned subsidiary of Constellation Software Inc. ("CSI", symbol CSU on the TSX), Harris has become the cornerstone for CSI's investment in utility, local government, school districts, public safety, and healthcare software verticals. Our success has been realized through investments in our proprietary software and market expertise. This focus, combined with acquiring businesses that build upon or complement our offerings, has helped drive our success. Harris will continue to growth through reinvestment - both in the people and products that we offer and making investments in acquiring new businesses.

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