IDALIS FERNANDEZ

• Managed an active caseload of approximately 85 members with complex medical, behavioral, and social needs, prioritizing interventions, outreach, and follow-up based on member needs and care-plan goals.
• Performed ongoing case assessment, member engagement, care coordination, and systematic case reviews to identify gaps in care, barriers to services, and opportunities for intervention.
• Conducted telephonic, SMS, and community-based outreach to engage members, assess needs, reinforce health goals, and support continuity of care.
• Developed and maintained Health Action Plans and Shared Care Plans in collaboration with members and multidisciplinary care teams.
• Collaborated with Nurse Care Managers, Behavioral Health Care Managers, Nurse Practitioners, Community Engagement Specialists, providers, health plans, and community resources to coordinate member-centered interventions.
• Identified and resolved barriers related to transportation, medication access, health literacy, social support, healthcare access, referrals, and appointment completion.
• Coordinated referrals, appointments, community resources, and follow-up services while monitoring progress toward identified goals.
• Maintained HIPAA-compliant case documentation, encounter records, and follow-up activity in accordance with health-plan requirements and monthly encounter expectations.
• Used ARC, insurance/health-plan platforms, CRM systems, Google Workspace, Microsoft Office, and telephonic/SMS platforms to manage cases, communication, documentation, and workflows.

Coordinated patient appointments, referrals, care-plan activities, and follow-up using Epic and CarePort, supporting timely access to appropriate healthcare services.

Verified insurance coverage and coordinated with patients, providers, and insurance organizations to identify and resolve care-access, scheduling, and coverage barriers.

Maintained 98% documentation accuracy while handling protected health information in accordance with HIPAA requirements.

Communicated with patients in English and Spanish to explain healthcare processes, clarify next steps, support follow-up, and address concerns.

Managed multiple patient coordination priorities in a high-volume environment while maintaining accurate records and timely case activity.

Falck Global Assistance | Case Manager | 02/2020 – 11/2025

Managed complex medical assistance cases from initial assessment through resolution, coordinating services and care plans for emergency and non-emergency situations.

• Assessed patient needs, coordinated appropriate resources, adapted care plans, and maintained ongoing follow-up with patients, hospitals, healthcare providers, airlines, and service partners.
• Maintained 95%+ case resolution within SLA requirements through proactive follow-up, prioritization, escalation, and cross-functional coordination.
• Coordinated multidisciplinary resources and communicated across hospitals, providers, service organizations, and clients in multiple regions to address medical and logistical barriers.
• Handled high-risk and time-sensitive cases requiring crisis intervention, sound judgment, rapid coordination, and clear communication.
• Educated clients regarding available programs, benefits, services, next steps, and coordination processes while providing empathetic support.
• Documented case activity, communications, interventions, and outcomes in CRM and Zendesk systems while maintaining confidentiality and regulatory compliance.

• Handled emergency and non-emergency cases, ensuring timely and effective resolutions.
• Collaborated with hospitals, airlines, and service providers across multiple regions.
• Maintained detailed case documentation using CRM and Zendesk systems.
• Achieved 95%+ resolution rate within SLA timelines.
• Facilitated crisis intervention strategies, enhancing client access to essential resources and support services.
• Monitored case progress, ensuring adherence to regulatory requirements and timely follow-up actions for high-risk cases.
• Maintained accurate documentation on all cases, ensuring compliance with regulations and confidentiality requirements.
• Educated clients on available programs, benefits, and services, empowering them to make informed decisions about their care needs.

• Supported case-related inquiries for government programs, ensuring accurate information delivery.
• Documented case interactions in CRM systems with high accuracy.
• Assisted clients with application processes and issue resolution.
• Improved first-call resolution rates through effective communication.
• Provided bilingual support to ensure accessibility for Spanish-speaking clients.
• Managed high-volume call flows more than 55 + daily efficiently, maintaining quality standards in every customer interactions.
• Managed high-volume inbound calls, effectively prioritizing issues to ensure swift resolution and minimize hold times for customers.
• Enhanced customer satisfaction by addressing and resolving complex inquiries in both English and Spanish languages.