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Utilization Case Manager Jobs in Toronto, ON (NOW HIRING)

Senior Disability Case Manager

Toronto, ON · On-site

CA$70K - CA$85K/yr

... interventions, utilization of specialized resources or consultations etc. * Determine an ... Attend Case Management and Disability Management department team meetings * Other projects and ...

New

... Case, Project Charter, RAID log, and others. **2. Stakeholder Engagement and Leadership ... Ensure optimal allocation and utilization of resources to achieve project goals. **6. Communication ...

New

... Case, Project Charter, RAID log, and others. **2. Stakeholder Engagement and Leadership ... Ensure optimal allocation and utilization of resources to achieve project goals. **6. Communication ...

New

Project Manager

Toronto, ON · On-site +1

$60K - $70K/yr

Your goal is to maximize and balance resource utilization of our team's capacity and inform our ... At the completion of a project, write project closure documents or case studies about the project ...

Power Automate experience: 5+ years * 7+ years Support resource utilization tracking and management ... use case, process, data flow, and data models · Conduct stakeholder engagement activities ...

... utilization, and understanding of programs. * Continuously improve self-service resources ... case management and employee support. Compliance & Risk Management: * Ensure ongoing compliance ...

Maintain granular, real-time visibility into team availability, skillsets, and utilization (e.g ... build the case for additional headcount when needed. * Forecast and roadmap staffing needs on a ...

... to managing complex case escalations and driving continuous process improvement. The Leave ... utilization to identify risks and recommend process improvements * Monitor legislative and ...

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Utilization Case Manager information

What is a utilization case manager?

A Utilization Case Manager is a healthcare professional responsible for evaluating the necessity, appropriateness, and efficiency of medical services provided to patients. They review patient cases, coordinate with healthcare providers, and ensure that treatments are in line with established guidelines and insurance requirements. Their goal is to optimize patient outcomes while managing costs and ensuring compliance with regulations. Utilization Case Managers often work in hospitals, insurance companies, or managed care organizations.

What are the key skills and qualifications needed to thrive as a utilization case manager?

To thrive as a Utilization Case Manager, you need a background in nursing or social work, strong analytical skills, and a solid understanding of healthcare regulations and insurance processes, often supported by RN licensure or certification in case management (e.g., CCM). Familiarity with utilization management software, electronic health records (EHRs), and payer authorization systems is essential. Excellent communication, critical thinking, and negotiation skills help facilitate collaboration among patients, providers, and payers. These skills ensure appropriate care delivery, cost management, and compliance with healthcare standards.

How does a utilization case manager typically collaborate with healthcare providers and insurance companies?

Utilization Case Managers play a key role in coordinating care between healthcare providers and insurance companies. They review patient cases to ensure that the recommended treatments are medically necessary and align with insurance policies. This often involves regular communication with doctors, nurses, and insurance representatives to gather information, clarify treatment plans, and advocate for appropriate patient care. Strong collaboration skills are essential, as Utilization Case Managers must balance the needs of patients with organizational guidelines while maintaining positive professional relationships.

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

AspectUtilization Case ManagerUtilization Review Nurse
CredentialsRN license, case management certificationRN license, certification in utilization review
Work EnvironmentCase management teams, hospitals, insurance companiesUtilization review departments, hospitals, insurance providers
Primary FocusCoordinating patient care, discharge planning, resource allocationAssessing medical necessity, reviewing patient records for appropriateness
Common UsageBroader case management roles, patient advocacySpecific review of medical necessity and insurance claims

While both roles require RN licensure and focus on patient care, the Utilization Case Manager primarily coordinates overall patient services and discharge planning, whereas the Utilization Review Nurse concentrates on evaluating the medical necessity of treatments for insurance purposes. Understanding these distinctions helps in choosing the right career path or job search focus.

What degree do I need for utilization case manager?

Utilization case managers typically need at least a bachelor's degree in healthcare, social work, nursing, or a related field. Some positions may prefer or require a master's degree or relevant certifications, such as Certified Case Manager (CCM) or Certified Professional in Healthcare Quality (CPHQ).

What are popular job titles related to Utilization Case Manager jobs in Toronto, ON?

For Utilization Case Manager jobs in Toronto, ON, the most frequently searched job titles are:

What job categories do people searching Utilization Case Manager jobs in Toronto, ON look for?

The top searched job categories for Utilization Case Manager jobs in Toronto, ON are:

Infographic showing various Utilization Case Manager job openings in Toronto, ON as of August 2026, with employment types broken down into 88% Full Time, 11% Part Time, and 1% Contract. Highlights an 80% Physical, 4% Hybrid, and 16% Remote job distribution.

Senior Disability Case Manager

Lifeworks

Toronto, ON • On-site

CA$70K - CA$85K/yr

Full-time

Medical, Retirement, PTO

Posted 3 days ago

New


Job description

TELUS Health is empowering every person to live their healthiest life. Guided by our vision, we are leveraging the power of our leading edge technology and focusing on the uniqueness of each individual to create the future of health. As a global-leading health and well-being provider - encompassing physical, mental and financial health - TELUS Health is improving health outcomes for consumers, patients, healthcare professionals, employers and employees.

Join our team and what we'll accomplish together
Our Disability Case Managers are responsible for assisting employees on behalf of their employer when the employee is off work or at risk of being off work for health reasons. They assess any barriers to a successful and timely return-to-work and engage with stakeholders to implement strategies that address those identified barriers and support employees' return to work or an appropriate alternative plan.
Disability Case Managers work with a talented and collaborative group of professionals in a dynamic role that provides ongoing learning and career development opportunities in absence and disability management.

What you'll do

  • Conduct case assessments, contacting the employee and their direct manager by telephone to explain the disability management process and gather information for assessment purposes
  • Develop and document an understanding of the situation and the factors supporting as well as inhibiting a successful return to work for the employee
  • Provide any of the following interventions: more in-depth assessment, medical management interventions, initiation and coordination of occupational and/or psychological interventions, utilization of specialized resources or consultations etc.
  • Determine an appropriate return-to-work (RTW) goal with the employee and the employer, provide active support for the RTW planning process between the employee and their supervisor and intervene when necessary
  • Communicate proactively with the employer's Human Resources representative regarding any case management issues that may impact the workplace and RTW planning
  • Manage the transition to long term disability (LTD) and provide medical and summary case management information to the LTD insurer to ensure a seamless transition
  • Accountability and responsibility for assigned case load in managing required tasks and relationships with stakeholders
  • Attend Case Management and Disability Management department team meetings
  • Other projects and tasks as assigned

Qualifications and Skills

What you bring

  • 2-5 years comprehensive experience in Disability Case Management or combination of experience and specialized education
  • Background education/course work in any of the following fields: occupational health, rehabilitation, legislation related to disability management, helping relationship skills, mediation, human resource management, disability insurance, psychological and workplace factors in disability would be an asset
  • Registration or professional status within the disability management or professional health sector would be an asset
  • Strong communication skills with exceptional customer service focus
  • Exemplary interpersonal skills and ability to approach difficult situations with empathy and sensitivity
  • Detail oriented focus with ability to work independently in fast paced environment
  • Excellent problem solving skills and ability to apply critical thinking to execute decision making on complex situations

Salary Range: $70,000 - $85,000
Actual total compensation will be determined based on factors such as knowledge, skills, performance and experience. We encourage all qualified candidates to apply, even if the posted salary range doesn't match your expectations. We're open to discussing competitive compensation packages tailored to your experience level and expertise.

TELUS Health offers rewarding benefits, which may vary per job function, such as:

  • Comprehensive total rewards package highlighting competitive salary and bonus structures, minimum 3 weeks of vacation, and flexible benefits plan to meet the needs of you and your family
  • Flexibility to work in-office, virtually or a combination of both
  • Generous company matched pension
  • Opportunity to give back to communities in which we work, live and serve
  • Career growth and learning & development opportunities to develop your skills
  • And much more...

Job Type: This is for a current vacancy.

A bit about us

We're a people-focused, customer-first, purpose-driven team who works together every day to innovate and do good. We improve lives through our technology solutions and foster a culture of innovation that empowers team members to solve complex problems and create remarkable human outcomes in a digital world.

TELUS is proud to foster an inclusive culture that embraces diversity. We are committed to fair employment practices and all qualified applicants will receive consideration for employment. We offer accommodation for applicants with disabilities, as required, during the recruitment process.

Disclaimer: In accordance with the TELUS Health Solutions Data Center Security Policy, as a condition of employment, all team members whose job functions require they work at a Data Center and/or have access to detailed knowledge of technology related to client service delivery, are subject to a Personnel Security Screening conducted through the Government of Canada.

Note for Quebec candidates: if knowledge of English is required for this position, it is because the team member will be asked, on a regular basis, to interact in English with external or internal parties or to use English applications or software as part of their tasks.

By applying to this role, you understand and agree that your information will be shared with the TELUS Group of Companies' Talent Acquisition team(s) and/or any leader(s) who will be part of the selection process.