Top 96 Planner Jobs in Aptos, Ca

Utilization Management and Discharge Planning RN
Santa Clara Family Health Plan —San Jose, CA
- $100,968 - $151,451 a year
- Temporary
- Hybrid work
- Nursing
- Skilled nursing facility
- RN License
- Wellness program
- Health insurance
Quick Apply
12d
Event & Sales Coordinator - Willow Heights Mansion
WILLOW HEIGHTS MANSION INC —Morgan Hill, CA
- $25 an hour
- Extended hours
- Marketing
- Mid-level
- Hotel
Sales Manager - Events & Weddings
HOLT WINES INC —Morgan Hill, CA
- $70,304 a year
- Full-time
- Marketing
- Mid-level
- Hotel
12d
Event Manager
Bath Planet —San Jose, CA
- $1,355 a week
- Extended hours
- Computer literacy
- Mid-level
- Driver's License
- Mileage reimbursement
- Health insurance
Quick Apply
12d
Guest Services Coordinator
MOUNT HERMON ASSOCIATION INCORPORATED —Mount Hermon, CA
- $18.43 - $22.64 an hour
- Overtime
- Bachelor of Science
- Mid-level
- Administrative experience
11d
Production Expeditor
JCSI —San Jose, CA
- $24 - $30 an hour
- Overtime
- ERP systems
- Mid-level
- 2 years
- Paid holidays
- Health insurance
Quick Apply
Assistant Director for Conference Services
University of California Santa Cruz —Santa Cruz, CA
- $100,000 - $110,000 a year
- Weekends as needed
- Hybrid work
- Inventory management
- Research
- Office
Senior Production & Materials Planner
DIGITAL DYNAMICS INC —Scotts Valley, CA
- $90,000 - $140,000 a year
- Analysis skills
- Senior level
- Business
- Health insurance
- 401(k)
Quick Apply
Production Scheduler/Planner III
Toray Advanced Composites USA,Inc —Morgan Hill, CA
- $80,000 - $107,000 a year
- Overtime
- 6 years
- English
- Mid-level
Quick Apply
8d
Part Time Events Coordinator-1
Michaels Stores —Capitola, CA
- $16.90 - $19.70 an hour
- Part-time
- Merchandising
- Experience working with children
- Organizational skills
- Health insurance
- Dental insurance
Reactive Shop Planner
Joby Aviation —Santa Cruz, CA
- $83,200 - $145,100 a year
- Full-time
- 5 years
- Forklift
- Ability to lift 50 pounds
- Employee stock purchase plan
- Disability insurance
Banquets Manager
La Bahia Resort and Spa —Santa Cruz, CA
- $80,000 - $90,000 a year
- Full-time
- Merchandising
- Mid-level
- Accounting
Quick Apply
PT Party and Event Host + Cashier
Michaels Stores —Capitola, CA
- $16.90 - $19.70 an hour
- Part-time
- Merchandising
- Cash register
- Experience working with children
- Health insurance
- Dental insurance
Wedding Coordinator & Banquet Operations
Wedgewood Weddings —San Jose, CA
- $28.84 an hour
- Overtime
- Team management
- Experience equivalent to degree accepted
- Entry level
- Paid holidays
- Health insurance
Quick Apply
2d
Associate Planner
BKF —Salinas, CA
- $83,000 - $106,000 a year
- Full-time
- Hybrid work
- Customer service
- Mid-level
- Office
- Profit sharing
- Paid holidays
Quick Apply
Principal Planner
EMC Planning Group —Monterey Bay, CA
- $120,000 - $180,000 a year
- Email
- Research
- Office
- Master's degree
Catering Sales Manager
Seascape Beach Resort —Aptos, CA
- $75 - $85,000 a year
- Full-time
- Microsoft Outlook
- Basic math
- English
Quick Apply
Senior Manager, Global Event Strategy & Experiences
Western Digital —San Jose, CA
- $170,600 - $227,400 a year
- Full-time
- Hybrid work
- Marketing
- Bachelor's degree
- Continuous improvement
- Health savings account
- AD&D insurance
Quick Apply
Lead, Strategic Workforce Planning & Analytics
Agilent Technologies Inc —Santa Clara, CA
- $210,528 - $328,950 a year
- Full-time
- Hybrid work
- 11+ years
- Office
- Finance
- Work from home
RCI Coordinator/Demand Planner
Snap-on Inc —San Jose, CA
- $67,000 - $80,000 a year
- Full-time
- Mid-level
- 3 years
- SQL

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planner jobs near aptos, ca

Utilization Management and Discharge Planning RN

Santa Clara Family Health Plan -
San Jose, CA

Quick Apply

Job Details

Temporary
$100,968 - $151,451 a year
12 days ago

Benefits

Wellness program
Health insurance
On-site gym
Dental insurance
401(k)
Flexible spending account
Tuition reimbursement
Paid time off
Employee assistance program
Vision insurance
401(k) matching
Life insurance
Referral program
Retirement plan

Qualifications

Medicare
Utilization review
Managed care
RN License
Pre-authorization review for utilization management
Case management
Utilization management
Centers for Medicare and Medicaid Services (CMS)
Healthcare compliance

Full Job Description

About Us:

Santa Clara Family Health Plan (SCFHP) is a local, community-based health plan dedicated to improving the health and well-being of the residents of Santa Clara County. Working in partnership with providers and community organizations, we serve our neighbors through our Medi-Cal and SCFHP DualConnect (HMO D-SNP) health care plans.

About the role:

The Utilization Management and Discharge Planning Nurse performs clinical review in accordance with applicable regulatory and professional standards for Organization Determination Requests using clinical experience and skills in a collaborative process to assess, plan, implement, coordinate and evaluate options to ensure appropriate utilization of member healthcare services and benefits for all lines-of-business in compliance with all applicable state and federal regulatory requirements, SCFHP policies and procedures, and business requirements.

Day to Day:

Conduct clinical review to ensure effective and appropriate utilization of benefits and services for prospective, concurrent and retrospective/claims review organization determination authorization requests within regulatory turnaround requirements for all SCFHP lines of business.
Complete authorization reviews by applying the appropriate clinical criteria/guidelines, policy, procedures and clinical judgment to render coverage determinations.
Document pre-admission status, including living arrangements, physical and mental function, social support, durable medical equipment (DME), and other services received.
Draft appropriate notification letters such as approval, denial, delay and modify notifications to providers and members and language threshold following regulatory requirements..
Perform onsite concurrent review activities, as needed in the home, facility or community setting. For Long Term Care UR RN: Conduct regularly scheduled on-site visits to contracted skilled nursing facilities to follow up on re-admissions, confirm member census, conduct member assessments and provide on-site utilization and concurrent review.
Review and monitor hospital or nursing facility census and internal reports to track, reconcile and update discrepancies in member case files. For Long Term UR RN: Monitor and oversee re-admission and transfer prevention strategy.
Facilitate and coordinate communication related to post discharge with member interdisciplinary care team (ICT) including physicians, specialists, public services, community agencies and vendors to ensure care plan development and coordination of benefits and services.
Apply the use of clinical judgment to identify and coordinate referrals to appropriate departments or programs for member identified continuity of care needs, such as Case Management, Behavioral Health, Managed Long Term Services and Supports (MLTSS), community resources, Pharmacy and Quality.
Proactively and collaboratively interface with external case management staff including delegates to facilitate discharge planning and care transitions.
Maintain adherence with Model of Care of CMC, LTSS and DHCS regulatory requirements.

About You:

Active California Board of Nursing License (RN) without restriction.
Minimum one year of licensed related health care experience.
Knowledge of managed care principles and practices with emphasis in Utilization Management and/or Case Management.
Knowledge of MediCal and/or Medicare guidelines and regulations.
One year of experience with a Managed Care Health Plan.
Knowledge of Milliman/MCG guidelines or other nationally accredited utilization review criteria or standards.
Ability to make determinations based on Nursing knowledge when no criteria are available or applicable.
Ability to consistently meet accuracy and timeline requirements to maintain regulatory compliance.
Clinical knowledge and critical thinking skills with the ability to assess individualized whole-person care needs necessary to develop an effective care plan.
Experience working with designated member population (e.g. behavioral health, seniors and persons with disabilities, children).

Please review the full job description on our Career’s page: https://phf.tbe.taleo.net/phf04/ats/careers/v2/viewRequisition?org=SANTCLAR2&cws=38&rid=3170

Job Type: Temporary

Pay: $100,968.00 - $151,451.00 per year

Benefits:

401(k)
401(k) matching
Dental insurance
Employee assistance program
Flexible spending account
Health insurance
Life insurance
On-site gym
Paid time off
Referral program
Retirement plan
Tuition reimbursement
Vision insurance
Wellness program

Application Question(s):

Do you have Knowledge of Milliman/MCG guidelines or other nationally accredited utilization review criteria or standards?
Do you have experience in reviewing clinical criteria to make determinations?

Experience:

licensed related health care: 1 year (Required)
Managed Care Health Plan: 1 year (Preferred)
MediCal and/or Medicare : 1 year (Required)

License/Certification:

RN License (Required)

Work Location: Hybrid remote in San Jose, CA 95119

Quick Apply

Refine Your Search

planner jobs in aptos, ca

Utilization Management and Discharge Planning RN

Event & Sales Coordinator - Willow Heights Mansion

Sales Manager - Events & Weddings

Event Manager

Guest Services Coordinator

Production Expeditor

Assistant Director for Conference Services

Senior Production & Materials Planner

Production Scheduler/Planner III

Part Time Events Coordinator-1

Reactive Shop Planner

Banquets Manager

PT Party and Event Host + Cashier

Wedding Coordinator & Banquet Operations

Associate Planner

Principal Planner

Catering Sales Manager

Senior Manager, Global Event Strategy & Experiences

Lead, Strategic Workforce Planning & Analytics

RCI Coordinator/Demand Planner

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