Director of Clinical Resource Optimization

6 days ago


Toronto, Ontario, Canada Prime Healthcare Full time

**Overview of Prime Healthcare**

Prime Healthcare operates 45 hospitals and has over 300 outpatient locations in 14 states, serving more than 2.6 million patients annually. Our team of nearly 50,000 employees and physicians strives to deliver exceptional care.

Job Description:**

The Corporate Director of Clinical Utilization Management directs the utilization review process for our Employee Health Plans, ensuring adherence to EPO Plan Documents and other applicable documents. This role involves coordinating services using continuous quality improvement initiatives to promote positive member outcomes.

Main Responsibilities:

  • Integrate and coordinate services to promote positive member outcomes.
  • Frequent executive-level reporting and tracking on department and individual team productivity.
  • Assess needs, plan, communicate, design services, and strategies to forward the mission and serve member needs.
  • Provide strategic leadership, development, and supervision to the utilization review department.
  • Collaborate with facility-based case managers and discharge planners to ensure seamless coordination.

Key Qualifications:

  • Bachelor's degree in Nursing, Healthcare Administration, or a related field.
  • A minimum of seven years' experience in Clinical Utilization Review or Case Management with a large Health Plan.
  • An active CA Registered Nurse license.
  • Current BCLS (AHA) certificate upon hire and maintain current.
  • Excellent analytical and communication skills.
  • Knowledge of Milliman Care Guidelines, InterQual Criteria, and CMS Criteria.
  • Knowledge of self-funded health plans, ERISA, and HIPAA guidelines.

What We Offer:

  • Competitive compensation and benefits package.
  • Tuition reimbursement and professional development opportunities.
  • A comprehensive employee recognition program.


  • Toronto, Ontario, Canada Sinai Health System Full time

    Job Description:Sinai Health System is seeking a Clinical Informatics Director to lead the development and implementation of health information systems that support safe, high-quality, efficient patient care.The successful candidate will have a Master's degree in Nursing, Informatics, or Information Systems, and certification in Health Informatics. They will...


  • Toronto, Ontario, Canada SickKids Full time

    About This Role:The Business Analyst position at SickKids requires a detail-oriented individual with strong analytical skills and the ability to work independently. The successful candidate will be responsible for supporting OR leadership and clinical teams in interpreting, understanding, and applying operational data to make informed decisions.Key...


  • Toronto, Ontario, Canada MedSpa Partners Inc. Full time

    Job SummaryWe're seeking an experienced Marketing Manager to join our team at MedSpa Partners Inc. as a Clinic Marketing Manager. In this role, you'll lead the planning and implementation of clinic marketing strategies, manage team resources, and collaborate with partners on Clinic Operations to develop aligned 52-week marketing plans.You'll work closely...


  • Toronto, Ontario, Canada Create Fertility Centre Full time

    Create Fertility Centre is seeking a visionary Chief Operating Officer (COO) to drive operational excellence, implement scalable systems, and enhance patient experiences.Job OverviewThe COO will oversee daily operations, optimize clinical and administrative workflows, and ensure seamless coordination between departments. This role requires a leader with deep...


  • Toronto, Ontario, Canada Compunnel, Inc. Full time

    Compunnel, Inc. is seeking an experienced IT Cost Optimization Director to lead the end-to-end management of a global IT software cost optimization program.Job DescriptionThe ideal candidate will have a proven track record in the IT sector, strong leadership skills, and the ability to drive results while managing cross-functional teams.Main...


  • Toronto, Ontario, Canada ANNISAA Organization of Canada Full time

    Job Title: Co-Director of Human ResourcesDepartment: Human ResourcesStatus: Volunteer, Ongoing (More than 1 year); 10 hours per week (may increase as needed)Reports to: Director of Human ResourcesJob ID: #25-HR-02Posting Date: February 16, 2025Closing Date: March 3, 2025We are dedicated to promoting diversity, equity, and inclusion in professional...


  • Toronto, Ontario, Canada ANNISAA Organization of Canada Full time

    Job Title: Co-Director of Human ResourcesDepartment: Human ResourcesStatus: Volunteer, Ongoing (More than 1 year); 10 hours per week (may increase as needed)Reports to: Director of Human ResourcesJob ID: #25-HR-02Posting Date: February 16, 2025Closing Date: March 3, 2025We are dedicated to promoting diversity, equity, and inclusion in professional...


  • Toronto, Ontario, Canada ANNISAA Organization of Canada Full time

    Job Title: Co-Director of Human ResourcesWe are dedicated to promoting diversity, equity, and inclusion in professional environments. Our vision is to advance girls and women in leadership with a mission that focuses on developing and placing them in leadership roles.Responsibilities:Collaborate on HR Policy Development and Compliance: Work alongside the...


  • Toronto, Ontario, Canada MedSpa Partners Inc. Full time

    ResponsibilitiesAs our Clinic Marketing Manager, you'll be responsible for leading the planning and implementation of clinic marketing strategies, managing team resources, and collaborating closely with partners on Clinic Operations to develop aligned 52-week marketing plans.You'll work closely with the Director of Clinic Marketing to support clinic...


  • Toronto, Ontario, Canada Create Fertility Centre Full time

    Job Title:Fertility Operations DirectorCompany Overview:Create Fertility Centre is a leading fertility clinic dedicated to providing cutting-edge reproductive healthcare with a patient-centered approach.About the Role:This highly experienced and strategic Chief Operating Officer will lead operational efficiencies, implement scalable systems, and drive...


  • Toronto, Ontario, Canada Michael Garron Hospital Full time

    Job SummaryClinical Resource Leaders (CRLs) play a pivotal role in ensuring that patient care and services are delivered in accordance with the Hospital's vision and strategic goals. As a CRL, you will be responsible for advancing professional practice and clinical care excellence through the design and implementation of educational programs and clinical...


  • Toronto, Ontario, Canada Salesforce, Inc. Full time

    Sales Operations DirectorWe are seeking a highly experienced Sales Operations Director to lead our sales operations function.The successful candidate will be responsible for defining key performance metrics and targets, building reports and dashboards to derive insights into the health of the business, identifying areas of weakness, and presenting...


  • Toronto, Ontario, Canada Humber River Health Full time

    Position OverviewHumber River Health is a leading healthcare provider in North West Toronto, committed to delivering high-quality patient care and innovative clinical services. We are seeking an experienced Clinical Manager to join our team in the Cardio-Diagnostics and Respiratory Therapy Services Program.About the RoleThis is a permanent full-time...


  • Toronto, Ontario, Canada ANNISAA Organization of Canada Full time

    Job Title: Assistant Director of Human ResourcesDepartment: Human ResourcesStatus: Volunteer, Ongoing (More than 1 year); 10 hours per week (may increase as needed)Reports to: Director of Human ResourcesJob ID: #25-HR-03Posting Date: February 16, 2025Closing Date: March 3, 2025We are dedicated to promoting diversity, equity, and inclusion in professional...


  • Toronto, Ontario, Canada ANNISAA Organization of Canada Full time

    Job Title: Director of Human ResourcesDepartment: Human ResourcesStatus: Volunteer, Ongoing (More than 1 year); 10 hours per week (may increase as needed)Reports to: Executive DirectorJob ID: #25-HR-01Posting Date: February 18, 2025Closing Date: March 6, 2025At ANNISAA, we are deeply committed to promoting diversity, equity, and inclusion in professional...


  • Toronto, Ontario, Canada Mejuri Full time

    Job Summary:The Director of Inventory Optimization will be responsible for developing and implementing inventory optimization strategies to drive profitability and reduce waste. This includes analyzing and optimizing inventory performance, driving cross-functional collaboration, supporting assortment planning, leading in-season forecasting and replenishment,...


  • Toronto, Ontario, Canada Humber River Health Full time

    Position ProfileHumber River Health. Lighting New Ways In Healthcare.Since opening our doors in 2015 as North America's first fully digital hospital, we remain unwavering in our belief that we can change the hospital where we work, the community where we live, and the world of healthcare beyond our borders. Serving a community of 850,000 residents in North...


  • Toronto, Ontario, Canada Tbwa ChiatDay Inc Full time

    At ProteinQure, we are committed to revolutionizing the field of drug discovery. Our cutting-edge computational platform enables us to engineer peptides that target extracellular targets, paving the way for innovative treatments in oncology and beyond.We pride ourselves on our collaborative approach, working closely with industry leaders and partners to...


  • Toronto, Ontario, Canada Stella's Place Full time

    Clinical and Recovery Program OperationsEnsure all programs/services are inclusive, values-based, and delivered through a trauma-informed lens within an anti-oppression framework.Provide oversight to ensure clarity of program vision and delivery against key imperatives including integration of clinical, expressive art therapy, peer supports, and...


  • Toronto, Ontario, Canada ANNISAA Organization of Canada Full time

    About UsAt ANNISAA Organization of Canada, we believe in creating a positive and inclusive work environment that supports the growth and development of our team members. Our mission is to empower women in leadership through education, training, and mentorship.Job Title: Co-Director of Human ResourcesWe are seeking a seasoned human resources professional to...