Case Management Coordinator (Remote)

Help us elevate our patient care to a whole new level! Join our Aetna team as an industry leader in serving dual-eligible populations by utilizing best-in-class operating and clinical models. You can have a life-changing impac

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t on our Dual Eligible Special Needs Plan (DSNP) members, who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members’ health care and social determinant needs. Join us in this exciting opportunity as we grow and expand DSNP to change lives in new markets across the country.

Position Summary/Mission:

The Case Management Coordinator utilizes critical thinking and judgment to collaborate and inform the case management process, The Case Management Coordinator facilitates appropriate healthcare outcomes for members by providing assistance with appointment scheduling, identifying and assisting with accessing benefits and

education for members through the use of care management tools and resources.

Fundamental Components

  • Evaluation of Members: -Through the use of care management tools and information/data review, conducts a comprehensive evaluation of referred member’s needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating member’s benefit plan and available

internal and external programs/services.

  • Identifies high-risk factors and service needs that may impact member outcomes and care planning components with appropriate referral to clinical case management or crisis intervention as appropriate.
  • Coordinates and implements assigned care plan activities and monitors care plan progress.
  • Enhancement of Medical Appropriateness and Quality of Care: – Using a holistic approach consult with case managers, supervisors, Medical Directors, and/or other health programs to overcome barriers to meeting goals and objectives and present cases at case conferences to obtain a multidisciplinary review to achieve optimal outcomes.
  • Identifies and escalates quality of care issues through established channels.
  • Utilizes negotiation skills to secure appropriate options and services necessary to meet the member’s benefits and/or healthcare needs.
  • Utilizes influencing/ motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health.
  • Provides coaching, information, and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.
  • Helps member actively and knowledgeably participate with their provider in healthcare decision-making.
  • Monitoring, Evaluation, and Documentation of Care: – Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

Required Experience:

  • 2+ years experience in behavioral health, social services or appropriate related field equivalent to program focus
  • Ability to work Monday-Friday 8a-5p Pacific Standard Time.

Preferred Experience:

  • Case management and discharge planning experience preferred
  • Managed Care experience preferred

Education And Certification Requirements

  • Bachelor’s degree or non-licensed master level clinician with either degree being in behavioral health or human services preferred (psychology, social work, marriage and family therapy, counseling) or equivalent experience.

Top 10 Tips for Interview

  1. Keep your mind and body, relaxed.
  2. Never try to give a long answer to an interview question. Keep your answer short and effective.
  3. If you don’t know the answer to any question, do not try to mislead the interviewer because he knows everything. Here your answer should be just some simple words “Sorry Sir/Ma’am, I do not know the answer”.
  4. Your dress should be formal. The formal dress always leaves a good impact on the interviewer.
  5. Take permission from the interviewer before going inside the interview room by saying “May I come in Sir/Madam?”.
  6. Do not shake your leg and hand again and again.
  7. Your clothes should be neat and clean.
  8. If the interviewer asks the question in English/Hindi, you should answer in the same language. If you are not comfortable in that language, you should ask your interviewer “I am not comfortable in English/Hindi. Sir, Can I answer in ‘your comfortable language’”. Do not try to give the answer in which language you are not comfortable because in this situation. You would not be able to give your 100% in that language.
  9. How much time you will stay in the interview room, do not be out of focus. Your focus should be on the interviewer. Do not miss any single word out of what he would be asking. Because if you do so, you will need to listen to that question again. And trust me, guys. This is a very bad impact. So try to understand and listen to the question properly at once.
  10. Before leaving the room. You should say ‘Thank you to your interviewer’

Some rules which are followed in good companies by good employees. About what you should know so that you may easily adapt them, given below.

  1. Company always wants you to be on time and you should be.
  2. Take less leave from the office.
  3. Focus on your work and try to learn more.
  4. Speak from your work not for your mouth.
  5. Keep on trying to get new things from your seniors, regarding your profile.
  6. Raise your point but only then when you are 100% sure about your point.
  7. Never hurry because haste makes waste.
  8. For earning some extra points than others. Just play out of your comfort zone.
  9. Always respect your seniors.
  10. Learn from mistakes made by you and others and do not try to repeat them.

Some Common Interview Question You Could Be Asked

  1. Tell me about yourself describe yourself or give your introduction.
  2. Why are you leaving your current company?
  3. How will you take our company ahead from here with the help of your work?
  4. Are you comfortable with our company’s work timing?
  5. Why should we hire you for this position?
  6. How much do you expect as a salary?

Answers should be given below.

  1. Introduction:
  1. My name is ‘NAME’,
  2. I have done ‘QUALIFICATION’,
  3. I am from ‘Location’,
  4. Currently I am working in ‘Company Name’ “Ignore if fresher”
  5. My current position is ‘Position Name’ “Ignore if fresher”
  6. I am working on ‘Project Name’ “Ignore if fresher”

Why USA is a Good Place to Work on for Foreigners

  1. Money (Most Important Reason):

As we all know 99.99% people do jobs only because of money and in America (USA) the monthly average salary is $5500. A graph is given below to understand easily.

Countries USA Dolor Other Currencies
India 5500 429382
China 5500 36898
Nigeria 5500 2,305,710
Nepal 5500 700,393.10
Canada 5500 7,027.08
Pakistan 5500 1,201,750
Brazil 5500 27,920
Sri Lanka 5500 1,979,616

 

  1. Safety in USA:

If you live in America then you can say that you are one of those people in America who are the safest in this planet.

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