As a Care Coordinator, you will serve as the primary point of contact for members navigating complex healthcare needs. In this role, you will oversee and coordinate the delivery of healthcare services from initial intake through to case resolution, ensuring care is medically appropriate, cost-effective, and aligned with policy provisions and clinical best practices.
Working collaboratively with members, healthcare providers, employers, insurers, and internal teams, you will build strong relationships, facilitate informed decision-making, and ensure a seamless and positive member experience. This role requires exceptional communication skills, sound judgment, empathy, and a high degree of emotional intelligence to effectively support members through sensitive and often challenging healthcare situations.
The ideal candidate is a proactive, solutions-oriented professional who thrives in a fast-paced environment, demonstrates outstanding interpersonal and relationship-management abilities, and is committed to delivering a high standard of service while balancing member needs, clinical considerations, and business objectives.
PRIMARY DUTIES AND RESPONSIBILITIES:
- Assess member eligibility and benefits based on their medical insurance policy, ensuring accurate interpretation and application of plan rules.· Coordinate complex medical cases by acting as a central liaison between members, healthcare providers, insurers, and internal stakeholders to ensure timely and effective care delivery.
- Evaluate treatment pathways and facilitate access to clinically appropriate, cost-effective care solutions through preferred provider networks and strategic collaboration with Relationship Management and Medical teams.
- 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.
- Manage sensitive and complex member interactions with empathy, professionalism, and a high degree of emotional intelligence, particularly during challenging or stressful situations.
- Proactively identify barriers to care and recommend practical solutions that balance member needs, clinical considerations, and policy requirements.
- 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.
- Contribute to continuous improvement initiatives by identifying opportunities to enhance member experience, service delivery, and operational processes.
- Provide support during rotating after-hours and holiday coverage as needed
- Undertake any other duties and responsibilities as needed
QUALIFICATIONS, EXPERIENCE & ATTRIBUTES:
- Minimum 5-7 years of progressive 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
- Strong knowledge of medical terminology and healthcare environments; experience with health insurance, benefits, or claims administration is preferred.
- Exceptional interpersonal, relationship-building, and stakeholder management skills, with the ability to establish credibility and trust with members, providers, and internal partners.
- High emotional intelligence and empathy, with the ability to navigate sensitive conversations and support individuals through complex healthcare situations.
- Excellent verbal and written communication skills, including the ability to influence, negotiate, and communicate effectively with diverse audiences.
- Strong analytical, critical-thinking, and problem-solving abilities, with sound judgment and attention to detail.
- Proven ability to manage multiple priorities and complex cases in a fast-paced, customer-focused environment.
- Demonstrated commitment to delivering an exceptional member experience through a compassionate and service-oriented approach.
- Professionalism, discretion, and confidentiality when handling sensitive information.
- Proficiency in Microsoft Office applications and the ability to learn new systems and processes quickly.
- Resilient, adaptable, and collaborative, with a strong sense of accountability and ownership.
SALARY:
The actual pay may be below or above the range based on candidates’ knowledge, skills, and level of ability relative to expectations for the role applied to. Candidates with salary expectations outside of the range are encouraged to apply.
ACCOMODATIONS:
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.
DISCLOSURE STATEMENT:
This role is an existing vacancy with our organization.
Job Types: Permanent, Full-time
Pay: $55,000.00-$75,000.00 per year
Benefits:
- Extended health care
- RRSP match
- Work from home
Application question(s):
- What are your salary expectations? Please provide a range
Experience:
- third party insurance: 2 years (preferred)
- health claims: 2 years (preferred)
Work Location: Hybrid remote in North York, ON M2J 4Y1
