Case Manager

5 days ago

North York ON MJ Y, Canada One Team Health Full time

One Team Health is seeking a dedicated and compassionate Case Manager to join our team. As a Case Manager, you will play a key role in managing healthcare services for members from the initial request through to the completion of care. You'll ensure that services are eligible, medically appropriate, and compliant with policy guidelines, while serving as a key point of contact, coordinating and communicating with members, healthcare providers, and employers.

We're looking for someone who is organized, empathetic, and proactive—someone who thrives in a fast-paced, service-driven environment and is committed to delivering exceptional support and care coordination.

PRIMARY DUTIES AND RESPONSIBILITIES:

  • Assess member eligibility and benefits based on their medical insurance policy
  • Facilitate care coordination by serving as a liaison among patients, providers, and payers
  • Present cost-effective treatment options using in-network facilities and collaboration with the Relationship Management team
  • Assess appropriate diagnostic testing and treatment plans as outlined in guidelines and as determined by the medical team
  • Maintain clear and accurate documentation of case activities, treatment plans, and financial obligations
  • Provide guidance and support to insured members throughout their medical treatment
  • Adhere to all policies and procedures as outlined by the company and client specific protocols
  • Ensure case documentation meets privacy regulations (PIPEDA, HIPAA, PIPA) and internal confidentiality standards
  • Provide support during rotating after-hours and holiday coverage as needed
  • Undertake any other duties and responsibilities as needed

REQUIREMENTS:

  • 2-5 years of experience in the healthcare/medical administration, case management or insurance-related fields
  • Education or background as a Registered Practical Nurse (RPN), Social Worker, or other healthcare professional strongly preferred but not required
  • Familiarity with medical terminology and procedures (e.g., from a clinic, hospital, or healthcare setting)
  • University or College degree in a related field (e.g. Business Administration, Insurance, Healthcare etc.) or equivalent work experience
  • Math Skills: Calculating applicable discounts according to direct contract providers
  • Basic knowledge of insurance or claims processes is an asset
  • Strong organizational, communication, and problem-solving skills
  • Proficiency with Microsoft Office applications
  • Willingness to learn and grow in a dynamic and collaborative environment

In Ontario, One Team Health, and affiliated organizations accommodate the needs of job applicants throughout its recruitment and selection processes in accordance with the Ontario Human Rights Code and the Accessibility for Ontarians with Disabilities Act. Accommodation needs must be provided in advance. To discuss your needs, please contact the individual noted in the posting.

Job Types: Full-time, Permanent

Benefits:

  • Extended health care
  • RRSP match
  • Work from home

Application question(s):

  • What are your salary expectations for this role? Please provide a range

Experience:

  • Medical terminology or clinical/heathcare setting: 2 years (preferred)
  • health administration, case management or insurance field: 2 years (preferred)

Work Location: Hybrid remote in North York, ON M2J 4Y1

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