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Added 4 mins ago
UH
Human Rights and Programs Consultant
Unity Health Toronto
Toronto, ON
- Full-time
…workplace investigations (approximately 30–40 files), managing each case from initial intake and fact-finding through detailed evidence review, written reports, and leadership…
Added 4 mins ago
TI
Payroll Analyst
TekStaff IT Solutions
Toronto, ON · Greater Toronto Area, Canada
- Contract
Assist with employee payroll cases by reviewing information, completing required research, updating case notes, and routing or escalating items as appropriate.
Added 6 mins ago
M
Manager, National Human Resources (International Resourcing)
MNP
Montreal, QC · Drummondville, QC · Quebec, QC · Sherbrooke, QC · Brossard, QC
- Full-time
Make an impact with our National Human Capital team as a Manager. This role will be responsible for contributing to the Talent Strategy through the operational execution of International…
Added 6 mins ago
G
HR Business Partner, Employee Relations
Galderma
Toronto, ON
- $90,000 to $110,000 CAD / year
Demonstrated expertise in employee relations and case management skills, including the ability to assess, manage, and resolve complex workplace matters
Added 6 mins ago
IR
Regional Fundraising Manager - Ottawa/Quebec/Atlantic
Islamic Relief Canada
Ottawa, ON · Montreal, QC
- Full-time
Liaise with national events manager to plan for IRC events and speaker tours
Added 6 mins ago
Indigenous Youth Outreach Worker
Durham Community Health Centre
Oshawa, ON
Position Reports To: Manager, Integrated care and Experience
Added 8 mins ago
Unit Supervisor, Wood Street Campus
The Government of Nova Scotia
Truro, NS
…and development for Youth Workers who deliver treatment and case management…
Added 20 mins ago
HP
Senior US Corporate Tax Manager, CPA - (Hybrid)
Henderson Partners LLP - CPAs & Advisors
Oakville, ON
- Full-time
…and Advisors based in Oakville as a Senior US Corporate Tax…
Added 22 mins ago
TI
Software Developer - ERP / Case Management - Senior
Teckhorizon Inc
Toronto, ON
- Contract
…enrolment, and life events management, enhancing employee and manager self-service capabilities, and transitioning legacy Classic+ pages to PeopleSoft Fluid…
Added 22 mins ago
C
Technical Project Manager (AML)
CGI
Halifax, NS
- Full-time
CGI is seeking an experienced, delivery-focused Anti-Money Laundering (AML) Project Manager to lead medium to large-scale technology and business initiatives within a Tier 1 Canadian…
Added 24 mins ago
Associate Manager, Marketing Finance
The Hershey Company
Mississauga, ON
Reporting to the Marketing Finance Manager, the Associate Manager, Marketing Finance is accountable for providing financial leadership for a portfolio of chocolate, sweets, and seasons…
Added 38 mins ago
GO
Client Services Officer A
Government of Newfoundland and Labrador
Channel-Port aux Basques, NL
- $31.37 to $34.89 CAD / hour
- Full-time
Reporting to the Client Services Manager, the Client Services Officer A provides comprehensive and quality front-line service to clients enquiring about programs offered by Income Support…
Added 38 mins ago
A
Bilingual Production Order Analyst, Financial Investigations
Altis
Ottawa, ON
- Contract
2+ years of relevant experience in financial operations, fraud investigations, legal documentation, compliance or case management preferred.
Added 38 mins ago
DC
Indigenous Youth Outreach Worker
Durham Community Health Centre
Oshawa, ON
- Full-time
Position Reports To: Manager, Integrated care and Experience
Added 38 mins ago
TH
Associate Manager, Marketing Finance
The Hershey Company
Mississauga, ON
- Full-time
Reporting to the Marketing Finance Manager, the Associate Manager, Marketing Finance is accountable for providing financial leadership for a portfolio of chocolate, sweets, and seasons…
Added 1 hour ago
OP
Assistant Project Leader
Ontario Power Generation
Pickering, ON
- Full-time
Reporting to the Manager, Projects, this position is responsible for administering the organization, coordination and execution of assigned project(s) within multidiscipline project…
Added 1 hour ago
DC
Outreach Worker - HART Hub
Durham Community Health Centre
Oshawa, ON
- Full-time
Provide a range of Outreach support services, including short and long-term case management that promotes wholistic wellbeing for those experiencing homelessness, at risk of homeless or in…
Added 1 hour ago
DC
Outreach Worker - HART Hub
Durham Community Health Centre
Whitby, ON
- Full-time
Provide a range of Outreach support services, including short and long-term case management that promotes wholistic wellbeing for those experiencing homelessness, at risk of homeless or in…
Added 1 hour ago
HF
Mental Health Counsellors - Full Time & Part-Time
Hamilton Family Health Team
Hamilton, ON
- Full-time
- Part-time
Performs other job functions as assigned by the Clinical Manager
Added 1 hour ago
B
Coordinator, CPA Program
BDO
Barrie, ON · London, ON · Toronto, ON · Ottawa, ON · Oakville, ON · Vancouver, BC
- Full-time
Reporting to the National Manager, CPA Student Programs, the Coordinator, CPA Program provides day-to-day administrative and operational support to CPA students across the firm. This…
Added 1 hour ago
B
Coordinator, CPA Program
BDO
Halifax, NS · Calgary, AB
- Full-time
Reporting to the National Manager, CPA Student Programs, the Coordinator, CPA Program provides day-to-day administrative and operational support to CPA students across the firm. This role…
Added 1 hour ago
Outreach Worker - HART Hub
Durham Community Health Centre
Whitby, ON
Provide a range of Outreach support services, including short and long-term case management that promotes wholistic wellbeing for those experiencing homelessness, at risk of homeless or in…
Added 1 hour ago
Outreach Worker - HART Hub
Durham Community Health Centre
Oshawa, ON
Provide a range of Outreach support services, including short and long-term case management that promotes wholistic wellbeing for those experiencing homelessness, at risk of homeless or in…
Added 1 hour ago
NC
Program Worker
Neighbours Community Homes
Toronto, ON
- Temporary
Under the supervision of the Program Manager, the Program Worker is responsible for providing leadership and to design and lead activities that help tenants become engaged in the community,…
Added 1 hour ago
Client Services Officer A
Department of Social Supports and Well-Being
Channel-Port aux Basques, NL · Stephenville, NL
Reporting to the Client Services Manager, the Client Services Officer A provides comprehensive and quality front-line service to clients enquiring about programs offered by Income Support…

Closed listing

Jobgether

Drug Prior Authorization Case Manager

Canada

Competitive salary range of $43,875–$73,125 CAD, depending on location, qualifications, experience, and other job-related factors. · Full-time

This opening has closed.

The original listing is kept below for reference.

Find open jobs More jobs with this employer

About employer

Job details

Pay: Competitive salary range of $43,875–$73,125 CAD, depending on location, qualifications, experience, and other job-related factors.
Job type: Full-time
Experience: 2–3 years of experience in a customer-focused environment, case management, claims, or a related field.
Posting language: English
Posted: Oct 4, 2026

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Original job description

Archived listing. The details below describe a past opening.

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

This role is responsible for the end-to-end management of complex drug prior authorization and claims cases.

You will independently assess requests against clinical guidelines, plan provisions, and approval criteria while ensuring accurate and timely decisions.

The position involves direct communication with members, providers, pharmacies, and internal stakeholders.

You will handle sensitive, escalated, high-value, and non-standard cases that require research, sound judgment, and detailed analysis.

As a subject matter expert, you will also support internal teams, outsource partners, training, and knowledge-sharing initiatives.

The role combines customer service, claims expertise, risk management, and continuous improvement within a collaborative and evolving environment.

Accountabilities

Manage the intake, review, and adjudication of drug prior authorization requests, evaluating submissions against clinical guidelines, plan provisions, and established approval criteria.
Take full ownership of assigned cases from initial intake through resolution, prioritizing work according to urgency, complexity, customer impact, and service-level requirements.
Communicate authorization and claim outcomes clearly and professionally to members, healthcare providers, pharmacies, and internal stakeholders while maintaining expected turnaround times.
Investigate and resolve complex, escalated, sensitive, high-value, and non-standard claims or authorization scenarios through detailed research, analysis, and sound judgment.
Serve as a subject matter expert in prior authorization and claims adjudication, providing guidance to internal teams and external or outsourced partners.
Apply risk-management principles when assessing requests and contribute to effective resolution of escalated claims issues.
Participate in initiatives focused on operational efficiency, quality, customer experience, knowledge sharing, training, and continuous improvement.
Support broader organizational objectives related to financial efficiency, customer satisfaction, operational performance, and strategic priorities.

Requirements

Post-secondary education or an equivalent combination of education and relevant professional experience.
2–3 years of experience in a customer-focused environment, case management, claims, or a related field.
Previous experience in group benefits, claims management, disability management, insurance, or another regulated environment is required.
Proficiency with Microsoft Office 365 and confidence working with digital tools and systems in a professional environment.
Knowledge of benefits administration, medical and dental terminology, or claims-related practices is an asset.
Excellent written and verbal communication skills, with the ability to interact effectively with a diverse range of internal and external stakeholders.
Strong analytical, problem-solving, decision-making, and investigative skills, with the ability to assess risk and resolve challenging situations.
Strong attention to detail, sound judgment, confidentiality, and a customer-focused approach are essential.
Ability to manage multiple priorities in a fast-paced and changing environment while working independently and collaborating effectively with a team.
Strong influencing, negotiation, collaboration, and relationship-building skills, combined with adaptability and a willingness to embrace new technologies.
A continuous improvement mindset, solution-oriented approach, and experience acting as a subject matter expert, mentor, or informal leader are considered valuable.

Benefits

Competitive salary range of $43,875–$73,125 CAD, depending on location, qualifications, experience, and other job-related factors.
Opportunity to participate in incentive programs with compensation linked to individual and business performance.
Hybrid working arrangement with WorkSmart flexibility available.
Comprehensive health and dental coverage, including mental health and vision benefits.
Short- and long-term disability, life, and AD&D insurance coverage.
Adoption, surrogacy, wellness, and employee/family assistance benefits.
Retirement savings options, including pension and a global share ownership plan with employer matching contributions.
Access to financial education and counseling resources.
Generous paid time off, including holidays, vacation, personal and sick days, plus applicable statutory leaves.
Flexible and inclusive working environment focused on employee well-being, professional development, and career growth.
Opportunity to contribute to a global organization while developing expertise in complex claims and prior authorization management.

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.

About employer

More about this job

Responsibilities

Manage drug prior authorization requests and claims from intake through resolution, assessing cases against clinical guidelines, plan provisions, and approval criteria while meeting service timelines. Resolve complex and escalated cases, communicate decisions to members and stakeholders, provide subject-matter guidance, and contribute to risk management, training, and operational improvement.

Requirements

Requires post-secondary education or equivalent relevant experience, along with 2–3 years in a customer-focused, case management, claims, or related role and experience in benefits, insurance, disability management, or another regulated environment. Candidates should have strong analytical, communication, investigative, and decision-making skills, proficiency with Microsoft Office 365, attention to detail, and the ability to manage competing priorities independently and collaboratively.

Skills

Drug Prior Authorization
Claims Adjudication
Case Management
Clinical Guideline Assessment
Risk Management
Complex Case Investigation
Analytical Skills
Problem-Solving
Decision-Making
Customer Service
Written and Verbal Communication
Stakeholder Management
Microsoft Office 365
Confidentiality
Negotiation
Continuous Improvement

Benefits

Incentive Programs
Hybrid Work Flexibility
Health Insurance
Dental Insurance
Mental Health Benefits
Vision Benefits
Short-Term Disability Insurance
Long-Term Disability Insurance
Life Insurance
AD&D Insurance
Adoption Benefits
Surrogacy Benefits
Wellness Benefits
Employee and Family Assistance Program
Pension
Global Share Ownership Plan
Employer Matching Contributions
Financial Education and Counseling
Paid Holidays
Vacation
Personal Days
Sick Days
Statutory Leaves
Professional Development

Visa sponsorship

Not detected in the job text

Keywords

Drug Prior Authorization
Claims Management
Claims Adjudication
Case Management
Clinical Guidelines
Plan Provisions
Approval Criteria
Group Benefits
Benefits Administration
Disability Management
Insurance
Medical Terminology
Dental Terminology
Risk Management
Escalated Claims
Microsoft Office 365
Digital Tools
Service-Level Requirements
Customer Experience
Stakeholder Communication
Operational Efficiency
Quality Improvement
Knowledge Sharing
Training
Confidentiality
Financial Efficiency

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