Roxana Fernandez
Orlando
Summary
Accomplished Licensed Clinical Social Worker and Certified Case Manager with over 15 years of experience in inpatient and outpatient medical case management, behavioral health, substance abuse, and managed care fields. Skilled in case management, psychosocial assessments, and streamlining procedures to enhance patient outcomes for Medicare Advantage, Medicaid, and Commercial plan patients. Confident and strategic communicator adept at engaging diverse audiences and creating impactful educational materials. Successfully led the implementation of behavioral health projects for payors and designated accounts within major health insurance organizations. Additionally certified as a Medical Bilingual Translator (Spanish).
Overview
12
12
years of professional experience
1
1
Certification
Work History
Clinical Mental Wellness Specialist
UHC/Optum
04.2025 - Current
- Maintained up-to-date knowledge of industry trends and best practices by participating in professional development opportunities and attending relevant conferences.
- Monitored client progress regularly, adjusting program components as needed to optimize results.
- Conducted thorough assessments to identify individual client needs, goals, and potential obstacles to mental health
- Developed strong rapport with clients, fostering trust and open communication throughout the coaching process.
- Provided ongoing support for clients in achieving their long-term health goals through regular consultations and followups.
- Enhanced client well-being by implementing personalized wellness plans and lifestyle coaching.
- Built strong relationships with members to promote health, wellness and available services.
- Enhanced team performance against goals by coaching and motivating clients.
Behavioral Health Care Advocate – United Healthcare Student Resources (UHCSR)
United Health Group/Optum – Florida
12.2017 - Current
- 2024 Sages Award co-nominee for development and implementation of UHCSR behavioral health program
- Created workflows streams for Care Advocate Role, produced job aid and training document, and implemented workflows within the UHCSR designated account; this includes engagement with college, graduate, and post-graduate student populations to educate on benefits of over 900 insurance plans with a focus on high utilization of behavioral health services for substance use, eating disorders, gender-affirming care, and post-partum depression, among other complex medical conditions
- Provide ongoing assessment of UHCSR program analytics for account reporting and process improvement
- Execute training for internal stakeholders on UHCSR referral process, clinical software, program implementation, and team cross-coverage
- Behavioral health consultant for gender-affirming care program targeting high utilization of healthcare resources
- Collaborate with internal departments (e.g. Billing and Claims, Special Investigative Unit) as Behavioral Health Subject Matter Expert with a focus on requirements for single-case agreements
- Lead patient case presentations and discussions in weekly multidisciplinary team meetings, including case escalations
- Facility-Based Care (FBC) Care Advocate
- Managed and administered inpatient behavioral health benefits for Medicaid and Medicare dual-eligible clients with mental health and substance use issues
- Reviewed clinical assessments for appropriateness of levels of care and need for additional clinical services
- Coordinated benefits and transitions between levels of care, including securing single case agreement
- Identified ways to add value to treatment plans, consulting with facility staff, and identifying appropriate community-based services for discharge planning
- Medical Behavioral Integration Specialist
- Facilitated implementation of behavioral health program for Prestige Managed Medical Assistance (MMA) and AvMed Medicare HMO plans
- Utilized advanced clinical skills to identify and engage high risk members insured under Medicaid, Medicare, and commercial plans with multiple co-morbidities
- Provided members and their families/caregivers with supportive follow up, monitoring, education, and referrals to psychiatric, medical, and psychosocial services
- Partnered with designated external providers and organizations to address member needs, gaps in care, and recovery goals of complex and high-risk members
- Collaborated with internal Optum Behavioral Health Services Teams to provide coordination of benefits for a seamless transition for members from inpatient setting to community-based services
- Engaged in interdisciplinary integration activities, clinical rounds, and other discussions with psychiatrists, nurses, case managers, medical partners and external entities (e.g. Department of Children & Families)
Humana Care Manager – Social Services
Humana – Florida
09.2013 - 07.2017
- Completed telephonic clinical assessments of dual-eligible Medicare/Medicaid members to assess physical and psychosocial well-being and ensure optimal resource use
- Created member care plans in collaboration with a multi-disciplinary team
- Coordinated care management including interventions such as education, resources, and referrals for patients with cancer, chronic pain, diabetes, congestive heart failure, substance abuse, etc.
- Prepared presentations on a variety of topics, such as substance abuse by the elderly and caregiving myths, for community education
Education
Master of Business Administration -
Capella University
01.2025
Bachelor of Arts - Psychology
Universidad Central
Master of Social Work - undefined
Barry University
Miami Shores, FL01.2002
Skills
- Holistic assessment
- Mindfulness techniques
- Relaxation techniques
- Health promotion
- Mental health support
- Health education
- Client motivation
- Wellness assessment
Accomplishments
- Collaborated with team of 6 multidisciplinary colleagues in the development of behavioral health program for college and university students
Certification
- Licensed Clinical Social Worker (SW8237), 2006
- Certified Clinical Trauma Professional (CCTP), 2021
- Certified Case Manager (CCM), Commission of Case Management, 2017
- Qualified Clinical Intern Supervisor in the State of Florida, 2008
- National Association of Social Workers (NASW), Member, Florida Chapter, 2000
Affiliations
- United Health Center for Clinician Advancement, Ambassador
- United Health Clinical Social Work Employee Resource Group, Member
- Social Work Month Celebration Committee, Member
- United Health Unidos Employee Resource Group, Member
- MindIgnite, Volunteer
Languages
Spanish
Full Professional
Timeline
Clinical Mental Wellness Specialist
UHC/Optum
04.2025 - Current
Behavioral Health Care Advocate – United Healthcare Student Resources (UHCSR)
United Health Group/Optum – Florida
12.2017 - Current
Humana Care Manager – Social Services
Humana – Florida
09.2013 - 07.2017
Bachelor of Arts - Psychology
Universidad Central
Master of Social Work - undefined
Barry University
Master of Business Administration -
Capella University
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