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Added 49 mins ago
S
Senior Medical Physicist, Radiation Therapy - BC Cancer - Kamloops/Kelowna
Sanya’k̓ula
Kelowna, BC
- Full-time
This position will initially be based at the BC Cancer Kelowna Centre to support onboarding, training, and early program development. This position is intended to be permanently based at…
Added 49 mins ago
LC
Strategic Analytics Consultant
Langara College
Canada
- Full-time
Under the general guidance of the leader of the designated operational area, this role acts as a primary resource and consults on business improvement, system transformation, and…
Added 1 hour ago
CC
Pharmacy Assistant (Training Provided) - Casual
CareRx Corporation
Peterborough, ON
- $18.5 to $20 USD / hour
- Full-time
…pharmacy services that make a real difference. As Canada's trusted leader in specialty pharmacy services for long-term care, retirement and congregate living communities, we are committed…
Added 1 hour ago
CC
Pharmacy Assistant, L1
CareRx Corporation
Victoria, BC
- $19 to $21 USD / hour
- Full-time
…pharmacy services that make a real difference. As Canada's trusted leader in specialty pharmacy services for long-term care, retirement and congregate living communities, we are committed…
Added 2 hours ago
CC
Pharmacy Assistant, L1
CareRx Corporation
Victoria, BC
- $19 to $21 USD / hour
- Full-time
…pharmacy services that make a real difference. As Canada's trusted leader in specialty pharmacy services for long-term care, retirement and congregate living communities, we are committed…
Added 2 hours ago
PM
Electrical Engineer
Prairie Machine
Saskatoon, SK
- Full-time
Prairie Machine is a global leader in the manufacturing and supply of heavy-duty equipment and technical solutions for the heavy industrial and mining industries. We are looking for people…
Added 2 hours ago
J
Case Manager – Drug Prior Authorization
Jobgether
Canada
- $43,875 to $73,125 CAD / year
- Full-time
Experience as a subject matter expert, mentor, or informal team leader is an asset.
Added 2 hours ago
RO
KidsFirst Home Visitor
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Regina, SK
- Full-time
Reports to: KidsFirst Team Leader/Manager of SFCSD
Added 2 hours ago
HR
Quality Assurance Intern (Winter 2027, 12months)
Hitachi Rail
Toronto, ON
- $23 to $30 CAD / hour
- Full-time
A chance to build your career with a global leader driving digital transformation and innovation that helps support sustainable future
Added 2 hours ago
FN
Machine Operator 3P- 2nd shift
FAMU National Alumni Association
Cambridge, ON
- Full-time
Rockwell Automation is a global technology leader focused on helping the world's manufacturers be more productive, sustainable, and agile. With more than 28,000 employees who make the world…
Added 3 hours ago
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Senior Manager, Client and Funding Services - Net Zero Acceleration
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Ottawa, ON · Greater Ottawa Metropolitan Area
- Full-time
…leadership, planning activities and management of all aspects of the Program to which they…
Added 4 hours ago
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New Home Inspector
ProFab Ontario
Vallée-Jonction, QC
- Full-time
Added 5 hours ago
W
Machine Operator (Day Shift: 5am - 5pm)
Wonderbrands
Mississauga, ON
- Other
Reporting to the Production Leader - Supervisor, the Operator will work in a fast-paced food production environment ensuring equipment is runninng smoothly and efficiently, products meet…
Added 5 hours ago
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Director - Diversity & Inclusion
Government of Yukon
Whitehorse, YT
- Full-time
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Added 6 hours ago
YO
Assistant Educator (PT Permanent) - Avalon Y
YMCA of the National Capital Region
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- Part-time
…to address critical social needs in our community. We are a leader and valued partner in creating a vibrant and healthy community where everyone belongs and can reach their full…
Added 6 hours ago
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Non-RECE Educator - Avalon Y
YMCA of the National Capital Region
ON · Orleans, ON
- Full-time
…to address critical social needs in our community. We are a leader and valued partner in creating a vibrant and healthy community where everyone belongs and can reach their full…
Added 6 hours ago
YO
RECE Educator - Avalon Y
YMCA of the National Capital Region
ON · Orleans, ON
- Full-time
…to address critical social needs in our community. We are a leader and valued partner in creating a vibrant and healthy community where everyone belongs and can reach their full…
Added 6 hours ago
D
Assistant Team Leader
Dollarama
Kingston, ON
- $18.1 to $18.6 CAD / hour
- Part-time
The Assistant Team Leader provides support to the management team in executing and overseeing daily retail store operations, ensuring excellent customer service, and maintaining a…
Added 6 hours ago
C
Assistant Deli Manager
Co-op
Morden, MB
- Full-time
Reporting to the Deli Manager, the Assistant Deli Manager is a hands-on leader who actively participates in the daily operations of the department, including food preparation,…
Added 7 hours ago
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Anaesthesia Assistant -Surgical Centre
Michael Garron Hospital
Toronto, ON
- Full-time
…diverse multi-cultural community of east Toronto. Recognized as a leader in workplace wellness and offering a quality work environment focused on learning and development, MGH invests in…
Added 7 hours ago
J
Talent Acquisition Manager
Jobgether
Canada
- Full-time
The Talent Acquisition Manager is a strategic HR leader responsible for shaping proactive talent acquisition strategies that support business growth and workforce needs.
Added 8 hours ago
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Executive Director
New Brunswick Bible Institute
Meadow Lake, SK
- Full-time
…its next chapter. The ED is the primary decision maker and leader at TPYC; implementing a strategy to deliver on the vision central to TPYC’s existence is the key responsibility of the role…
Added 8 hours ago
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Business Performance Coach
Avid Business Performance Group powered by ActionCOACH
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Added 8 hours ago
Technical Support Specialist - Bilingual French
Geotab
Oakville, ON · Waterloo, ON
Geotab ® is a global leader in IoT and connected transportation and certified “Great Place to Work™.” We are a company of diverse and talented individuals who work together to help…
Added 8 hours ago
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Technical Support Specialist - Bilingual French
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Oakville, ON
- Full-time
…technologies. If you love technology, and are keen to join an industry leader - we would love to hear from…

Jobgether

Case Manager – Drug Prior Authorization

Canada

$43,875 to $73,125 CAD / year · Full-time

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Applications open in a new tab.

Job details

Pay: $43,875 to $73,125 CAD / year
Job type: Full-time
Experience: 2–3 years of experience in a customer service, case management, claims processing, or related environment.
Posting language: English
Posted: Oct 5, 2026

Original job description

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Case Manager – Drug Prior Authorization based in Canada.

This role plays a key part in managing complex drug prior authorization requests and claims requiring specialized handling.

You will own cases end to end, assessing submissions against clinical guidelines, plan provisions, and established approval criteria.

You will also manage sensitive, escalated, non-standard, and high-value cases that require sound judgment and in-depth analysis.

The role involves regular communication with plan participants, healthcare providers, pharmacies, and internal stakeholders.

You will serve as a subject matter expert on prior authorization and claims adjudication, while supporting knowledge sharing and colleague training.

Your expertise will directly contribute to service quality, customer satisfaction, operational efficiency, and continuous improvement.

You will work in a dynamic, flexible, and collaborative environment that values professional development, sound decision-making, and operational excellence.

Accountabilities

Receive, analyze, and adjudicate drug prior authorization requests according to applicable clinical guidelines, plan provisions, and approval criteria.
Manage cases from initial receipt through resolution, prioritizing work according to urgency and complexity.
Investigate complex, non-standard, or escalated cases and conduct the necessary research to determine appropriate actions.
Review high-value claims and situations requiring additional analysis or specialized attention.
Clearly communicate claims decisions to plan participants, healthcare providers, pharmacies, and internal stakeholders while meeting established service standards and processing timelines.
Act as a subject matter expert on prior authorization and claims adjudication, providing guidance and support to internal teams and outsourced partners.
Apply risk-management principles and sound professional judgment when evaluating requests and resolving cases.
Manage escalated cases and contribute to their timely, accurate, and customer-focused resolution.
Participate in projects and initiatives designed to improve operational efficiency, quality, processes, and customer experience.
Contribute to quality assurance, training, mentoring, knowledge-sharing, and continuous improvement activities.
Support objectives related to customer satisfaction, financial efficiency, and broader strategic priorities.
Maintain accurate case documentation and protect confidential customer and organizational information.

Requirements

Postsecondary education or an equivalent combination of relevant education and experience.
2–3 years of experience in a customer service, case management, claims processing, or related environment.
Experience in group benefits, claims administration, disability, insurance, or another regulated environment.
Knowledge of benefits plan administration and medical and dental terminology or claims processes.
Proficiency with Microsoft Office 365 applications.
Experience analyzing complex cases, assessing risk, and resolving sensitive or challenging situations.
Excellent written and verbal communication skills, with the ability to interact effectively with a broad range of stakeholders.
Strong analytical, problem-solving, decision-making, and professional judgment skills.
Ability to manage multiple priorities in a dynamic and continuously changing environment.
Strong attention to detail and a high level of commitment to accuracy and confidentiality.
Ability to work independently while collaborating effectively with a multidisciplinary team.
Strong customer focus and the ability to build positive, professional relationships with stakeholders.
Strong influencing, negotiation, collaboration, and communication skills.
Adaptability when faced with process changes, new technologies, and competing priorities.
A proactive approach focused on continuous improvement, operational excellence, and solution finding.
Experience as a subject matter expert, mentor, or informal team leader is an asset.

Benefits

Indicative annual salary range of CAD $43,875–$73,125, depending on location, qualifications, skills, experience, and role requirements.
Eligibility for incentive programs and performance-based compensation tied to individual and organizational results.
WorkSmart flexible working arrangement.
Opportunities to work from locations including Waterloo, Toronto, Kitchener, Halifax, and Montreal.
Medical and dental coverage.
Mental health and vision care coverage.
Short- and long-term disability insurance and life insurance.
Accidental death and dismemberment insurance.
Employee and family assistance programs.
Retirement savings plans, including options with employer matching contributions.
International employee share ownership program with employer contributions, subject to eligibility.
Financial education and advisory resources.
Paid time off including statutory holidays, vacation, personal days, and sick leave.
Learning, professional development, and career growth opportunities.
Flexible and inclusive work environment focused on employee well-being, collaboration, and diversity.
Opportunities to contribute to continuous improvement initiatives and projects that positively impact the customer experience.

How Jobgether Works

We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team.

We appreciate your interest and wish you the best!

Why Apply Through Jobgether?

Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time.

We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses and identifying potential inconsistencies or verification signals in application materials based on available information. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.

Apply About employer

More about this job

Responsibilities

Manage drug prior authorization requests and claims from intake through resolution, applying clinical guidelines, plan provisions, and approval criteria while handling complex, escalated, and high-value cases. Communicate decisions to participants and stakeholders, provide subject matter expertise and colleague support, maintain accurate confidential records, and contribute to quality, training, and operational improvement initiatives.

Requirements

Requires postsecondary education or an equivalent combination of education and experience, along with 2–3 years in customer service, case management, claims processing, or a related environment. Candidates should have relevant benefits, insurance, or regulated-environment experience; strong analytical, communication, judgment, and organizational skills; Microsoft Office 365 proficiency; and the ability to manage sensitive cases accurately and confidentially.

Skills

Drug Prior Authorization
Claims Adjudication
Case Management
Complex Case Analysis
Risk Assessment
Decision-Making
Customer Service
Stakeholder Communication
Benefits Plan Administration
Medical and Dental Terminology
Microsoft Office 365
Problem-Solving
Negotiation
Quality Assurance
Training and Mentoring
Confidentiality

Benefits

Incentive Programs
Flexible Working Arrangement
Medical Coverage
Dental Coverage
Mental Health Coverage
Vision Care Coverage
Short-Term Disability Insurance
Long-Term Disability Insurance
Life Insurance
Accidental Death and Dismemberment Insurance
Employee and Family Assistance Programs
Retirement Savings Plans
Employer Matching Contributions
Employee Share Ownership Program
Financial Education and Advisory Resources
Paid Time Off
Professional Development and Career Growth

Visa sponsorship

Not detected in the job text

Keywords

Drug Prior Authorization
Claims Processing
Claims Adjudication
Clinical Guidelines
Benefits Plan Administration
Approval Criteria
Case Management
Complex Case Analysis
High-Value Claims
Risk Management
Customer Service
Stakeholder Communication
Medical Terminology
Dental Terminology
Group Benefits
Claims Administration
Insurance
Microsoft Office 365
Quality Assurance
Training
Mentoring
Knowledge Sharing
Continuous Improvement
Confidentiality
Operational Efficiency

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