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Utilization Reviewer Jobs in Ontario (NOW HIRING)

Compass Health Network

$36.29 - $39.29/hr

Provide licensure supervision and perform utilization review activities as assigned * Attend required trainings and maintain productivity expectations Master's degree in social work, marriage and ...

Magna

Paint Process Engineering Group Leader

Guelph, ON

CA$105K - CA$130K/yr

Lead team reviews of cycle times, overall efficiency, yield, utilization, and process performance. * Create and/or support weekly reporting and presentations summarizing overall yield, utilization ...

Omers

Lead, Space Strategy - MAC

Toronto, ON

... utilization reporting tools. * Knowledge of furniture standards, ergonomic workplace design, and workplace accessibility requirements. * Experience reviewing and processing invoices through systems ...

AlphaKOR

Cybersecurity Analyst

Windsor, ON · On-site

Review capacity and utilization trends. * Escalate infrastructure risks before service impact occurs. Security Compliance & Governance * Support cybersecurity audits and assessments. * Review ...

Magnus HRS

Dispatch & Technical Support Manager

Vaughan, ON · On-site

CA$100K - CA$115K/yr

Keep labour gross margin healthy through technician utilization, rework reduction, and efficient ... reviews, coaching, & corrective action. * Customer prioritization/tiering and escalations that ...

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Utilization Reviewer information

What is the difference between Utilization Reviewer vs Medical Coder?

AspectUtilization ReviewerMedical Coder
Required CredentialsTypically requires healthcare-related certifications, such as RHIT, RHIA, or CPCUsually requires coding certifications like CPC, CCS, or CCS-P
Work EnvironmentHealthcare facilities, insurance companies, or utilization review organizationsHospitals, clinics, or medical billing companies
Employer & Industry UsageUsed in insurance, managed care, and healthcare administrationUsed in medical billing, coding, and health information management

While both roles work within healthcare settings, Utilization Reviewers focus on evaluating the necessity of medical services for insurance and care management, whereas Medical Coders translate medical records into standardized codes for billing and documentation. Understanding these differences helps professionals choose the right career path or job search focus.

How does a utilization reviewer typically collaborate with healthcare providers to ensure appropriate patient care?

Utilization Reviewers work closely with physicians, nurses, and other healthcare professionals to assess the necessity and efficiency of medical services provided to patients. They review clinical documentation, verify that treatments meet established guidelines, and may discuss care plans directly with providers to clarify information or suggest alternatives. This collaboration ensures that patients receive appropriate care while controlling costs and complying with insurance or regulatory requirements. Effective communication and a thorough understanding of medical protocols are essential for success in this role.

What does a utilization reviewer do?

A Utilization Reviewer is a healthcare professional responsible for evaluating the necessity, appropriateness, and efficiency of medical services provided to patients. They review patient records, treatment plans, and insurance policies to ensure that care meets established guidelines and standards. Their role helps control healthcare costs while maintaining quality patient care and ensuring compliance with regulatory requirements. Utilization Reviewers often communicate with healthcare providers, insurance companies, and patients to gather information and make informed decisions.

What does a utilization reviewer do?

There are different types of Utilization Reviewer jobs, including Nurse Utilization Reviewers, Insurance Utilization Reviewers, Speech Therapy, Physical Therapy, and Occupational Therapy Utilization Reviewers. Regardless of the area of focus, a Utilization Reviewer is responsible for setting best practices, reviewing healthcare program requirements, ensuring the quality of care, controlling costs, and developing and implementing initiatives for review processes. Utilization Reviewers ensure compliance of programs, regularly audit patient and client records, work with staff to implement best practices and correct problem areas, monitor industry trends, and remain up-to-date and train others on industry standards and requirements.

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

To thrive as a Utilization Reviewer, you need a clinical background (such as RN or LCSW), in-depth knowledge of medical terminology, and an understanding of healthcare regulations and insurance guidelines. Familiarity with utilization management software, electronic health records (EHRs), and relevant certifications like CCM or URAC accreditation is typically required. Strong critical thinking, attention to detail, and effective communication skills help in evaluating patient care and collaborating with providers. These competencies are crucial for ensuring appropriate, cost-effective care while maintaining compliance with healthcare standards.
More about Utilization Reviewer jobs
What are popular job titles related to Utilization Reviewer jobs in Ontario? For Utilization Reviewer jobs in Ontario, the most frequently searched job titles are:
What job categories do people searching Utilization Reviewer jobs in Ontario look for? The top searched job categories for Utilization Reviewer jobs in Ontario are:
What are popular job titles related to Utilization Reviewer jobs in ON? For Utilization Reviewer jobs in ON, the most frequently searched job titles are:
Utilization Reviewer jobs near you
Infographic showing various Utilization Reviewer job openings in Ontario as of August 2026, with employment types broken down into 100% Full Time. Highlights an 100% In-person job distribution.

Coding Specialist - Clinical Utilization Services

Mackenzie Health

Richmond Hill, ON

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.

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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

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