Milagros Hernandez
Harrisburg ,PA
Summary
Health Navigator collaborates with members of health care team to develop medically appropriate and cost effective care initiatives to assess and coordinate chronic disease care management for patient population. Strong analytical and data management skills to exercise clinical judgment in interactions with physicians, payers, patients and families.
Overview
12
12
years of professional experience
Work History
Care Navigator
United Healthcare Group
01.2022 - Current
- Consistently maintained confidentiality while handling sensitive patient information in accordance with HIPAA guidelines.
- Reduced hospital readmissions for patients through proactive follow-up and continuous communication.
- Maintained detailed documentation of patient interactions, treatment plans, and progress notes for accurate recordkeeping.
- Identified potential barriers to care, implementing tailored solutions to improve outcomes.
- Completes about 20-30 outbound calls per day to DSNP members utilizing auto dialer and manual dialing
- Educates member on gaps in care and assists with scheduling provides
- Assists members with social determinants of health and links to community
- Identifies gaps in care and assists in closure of gaps
- Outreaches members on caseload consistent with program guidelines
- Consistently meets metrics, both quality & performance
- Provides excellent customer service to both members and providers
- Constantly maintains schedule adherence and good attendance
- Maintains confidential health information according to state and federal regulations including HIPAA
- Act as a Subject Matter Expert for other team members
- Manage the intake of members or the admission/discharge information post notification
- Work with hospitals, clinics, facilities and the clinical team to manage requests for services
Front Office Assistant
Patriot Home Care
03.2021 - 10.2021
- Answered and managed incoming and outgoing calls while recording accurate messages for distribution to office staff.
- Maintained professional and welcoming environment for clients, contributing to overall positive experience.
- Responded to inquiries from callers seeking information.
- Directed phone inquiries, answered customer questions, and scheduled appointments.
- Monitored Call Dashboard System in HHA Exchange and handled high inbound call volumes.
- Provided assistance and communication with Spanish-speaking caregivers and clients.
- Supported filing tasks and contributed to the smooth operation of the office.
- Greeted visitors and customers upon arrival, offered assistance, and answered questions to build rapport and retention.
- Enhanced customer satisfaction by promptly addressing inquiries and concerns at the front desk.
- Collaborated with team members to improve overall front office performance through consistent feedback and process improvement suggestions.
- Developed procedures for handling sensitive information, maintaining confidentiality and adhering to company policies.
- Supported staff members with administrative tasks, improving productivity across various departments.
Care Management Associate
Aetna
12.2018 - 03.2020
- Completed weekly scheduling and monthly department reports for case managers.
- Reduced hospital readmissions by closely monitoring patients'' progress and adjusting care plans as needed.
- Coordinated post-discharge care by communicating with outpatient clinics, community resources, agencies and families around patients' transitional care.
- Worked with insurance carriers to obtain authorization approvals for medications, supplies and equipment.
- Promoted and supported the quality and effectiveness of healthcare services.
- Answered phone calls and messages for 30-40-members to assist with scheduling appointments, and handling patient inquiries.
Customer Service Representative
Garden Court Health Supplies
12.2012 - 07.2016
- Managed high-stress situations effectively, maintaining professionalism under pressure while resolving disputes or conflicts.
- Resolved customer complaints with empathy, resulting in increased loyalty and repeat business.
- Handled escalated calls efficiently, finding satisfactory resolutions for both customers and company alike.
- Responded to customer requests for products, services, and company information.
Education
Bachelor Of Business Administration And Management - Health Administration
Southern New Hampshire University
Manchester, NH05.2026
Skills
- Patient confidentiality
- Healthcare Systems Knowledge
- Care Coordination
- Cultural Competency
Timeline
Care Navigator
United Healthcare Group
01.2022 - Current
Front Office Assistant
Patriot Home Care
03.2021 - 10.2021
Care Management Associate
Aetna
12.2018 - 03.2020
Customer Service Representative
Garden Court Health Supplies
12.2012 - 07.2016
Bachelor Of Business Administration And Management - Health Administration
Southern New Hampshire University
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