Carmen Spanier

Supporting governance and quality oversight Senior Quality Improvement Manager with a proven track record of driving measurable improvements in quality metrics and operational performance. Analytical and results-oriented professional with strong problem-solving abilities and exceptional attention to detail. Adept at leveraging Microsoft Excel and other data platforms to analyze both quantitative and qualitative data.

Skilled in conducting comprehensive data analyses, producing trend reports, and translating insights into actionable strategies. Proven ability to educate providers and implement targeted improvement initiatives that enhance performance and outcomes.

Senior Quality Improvement Manager - LUMINARE HEALTH

(2025-01)

• Led the successful transition of the Quality Department from Innovista Health to Luminare Health, ensuring continuity of operations and program stability
• Develop and implemented Standard Operating Procedures (SOPs) and workflows to support a seamless departmental transition and long-term operational efficiency
• Participated in business management training to strengthen leadership, operational, and strategic planning capabilities
• Play a key role in transitioning from manual documentation processes to a centralized, universal reporting platform, improving data accuracy and accessibility
• Oversee performance monitoring, quality metrics, and regulatory compliance across diverse quality improvement program
• Drive quality improvement initiatives to enhance clinical outcomes, member experience, and cost efficiency
• Collaborate with cross-functional teams and provider networks to implement data-driven strategies and best practices
• Ensure alignment with NCQA, state, and payer-specific quality standards and reporting requirements

Senior Quality Improvement Manager - INNOVISTA HEALTH SOLUTIONS

(2021-01 - 2025-01)

• Led and managed quality programs across Accountable Care Organizations (ACO), HMO, MSSP, Medicaid, and Medicare Advantage (HMO & PPO) lines of business
• Oversaw performance monitoring, quality metrics, and regulatory compliance for diverse quality improvement health programs
• Drove quality improvement initiatives to enhance clinical outcomes, member experience, and cost efficiency
• Collaborated with cross-functional teams and providers to implement data-driven strategies and best practices
• Ensured alignment with CMS, NCQA, state, and payer-specific quality standards and reporting requirements

Quality Improvement Manager - INNOVISTA HEALTH SOLUTIONS

(2017-01 - 2021-01)

• Served as Subject Matter Expert and strategic leader for Quality Improvement (QI) initiatives supporting Commercial and Medicare Advantage populations
• Directed end-to-end QI projects, including program development, implementation, monitoring, and performance optimization
• Led continuous quality improvement efforts by analyzing data trends, generating reports, and initiating corrective action plans in alignment with health plan requirements
• Developed and maintained QI programs, provider manuals, audit tools, policies, procedures, and operational guidelines
• Ensured full compliance with federal, state, and contractual requirements, as well as internal policies and procedures
• Oversaw relationships and performance of business partners, including health plans, vendors, and contractors
• Drove annual strategic planning and reporting for QI programs, aligning initiatives with organizational and medical group goals
• Designed and delivered training programs for QI staff, providers, and medical group personnel to improve performance on key measures (HEDIS, CAHPS, HOS, GPRO)
• Educated staff on reviewing and interpreting clinical data from multiple sources, including EMRs, claims data, medical records, and reporting systems (e.g., EZCap)
• Provided performance feedback and actionable insights to medical groups and providers to support continuous improvement
• Collaborated cross-functionally with internal departments to implement and enhance quality processes and workflows
• Participated in organizational initiatives, in-services, and continuous professional development activities

Senior Quality Improvement Coordinator - INNOVISTA HEALTH SOLUTIONS

(2016-01 - 2017-01)

• Indirectly supervised QI Coordinators, ensuring adherence to established quality standards and internal QI program guidelines
• Developed in-depth expertise in organizational policies, procedures, and operational workflows to support effective quality program execution
• Partnered with Account Management and Provider Relations to educate network physicians on organizational policies, procedures, and quality expectations
• Authored, maintained, and continuously updated quality management policies, procedures, and the annual Quality Improvement (QI) Program
• Monitored physician compliance with QI initiatives and studies, communicating performance status and identifying gaps to providers and leadership
• Reported performance deficiencies and improvement opportunities to Account Managers and key stakeholders
• Delivered provider education and training in collaboration with UM/QM Committees to improve compliance and quality outcomes
• Implemented targeted QI initiatives and outreach programs to enhance preventive care performance and population health outcomes
• Coordinated medical record retrieval and review processes to support HEDIS measures, quality studies, audits, and complaint investigations
• Compiled, analyzed, and submitted retrospective quality performance reports and required documentation within established timelines
• Designed and implemented office-based tracking systems (e.g., preventive care flowsheets) to improve documentation and care delivery
• Acted as liaison between clinical practices and IT systems, supporting integration across EMRs, medical group platforms, and health plan systems while ensuring PHI security
• Coordinated onsite provider meetings and facilitated collaboration between physicians and organizational leadership
• Prepared and presented Quality Management agenda items and performance updates at monthly UM/QM Committee meetings

Quality Improvement Specialist - CHICAGOLAND MEDICAL SERVICES ORGANIZATION

(2015-01 - 2016-01)

• Collected, analyzed, and interpreted quality metric data in alignment with HEDIS requirements, identifying trends and implementing targeted improvement strategies
• Educated physicians and medical office staff on best practices to improve quality performance and patient outcomes
• Collaborated with leadership to review case management and QI trends, identifying gaps and driving data-informed solutions
• Partnered directly with Medical Directors and physician champions to deliver education and influence quality performance across multiple forums
• Presented QI, case management, and complex case management updates at Utilization Management (UM) meetings and during provider site visits
• Developed, maintained, and delivered quality improvement training materials for staff and providers
• Trained new office staff on payer-specific QI requirements, ensuring compliance and program consistency
• Provided tools, resources, and ongoing support to QI staff and provider offices to achieve performance goals
• Conducted one-on-one consultations with Medical Directors to address barriers, resolve issues, and support quality improvement initiatives

Quality Management Specialist - NORTH AMERICAN MEDICAL MANAGEMENT

(2012-01 - 2015-01)

• Managed end-to-end Quality Improvement (QI) projects for multiple IPAs, including quality management education, data retrieval, entry, analysis, and reporting
• Delivered tailored quality improvement recommendations to HMO IPAs based on performance data, including monthly updates to Medical Leadership, post-project analyses, and physician report cards
• Educated physicians and office staff on Quality Management and HEDIS requirements in alignment with health plan contracts and organizational goals
• Served as a key liaison among Medical Directors, IPA/PHO leadership, health plans, and provider offices to ensure timely, accurate completion of QI initiatives and HEDIS data submission
• Conducted onsite facility reviews and medical record audits to prepare providers for health plan audits and site visits
• Coordinated and managed the full lifecycle of complaint and inquiry resolution processes
• Reviewed, updated, and maintained Quality Management (QM) forms and documentation on an annual basis
• Led member and provider outreach initiatives in collaboration with IPA leadership to improve engagement and care quality
• Partnered with IT to obtain and analyze administrative data and generate reports supporting QI initiatives
• Ensured provider compliance with regulatory and health plan standards by delivering clear guidance, tools, and documentation requirements
• Communicated health plan expectations through written materials and onsite provider engagement, ensuring understanding of QM and HEDIS requirements
• Reviewed submitted medical records for project compliance and provided actionable feedback to physicians and staff to close gaps

Peer Review Program and Data Manager - ACCESS COMMUNITY HEALTH NETWORK

(2006-01 - 2011-01)

• Managed the Peer Review Program, supporting organizational Performance and Quality Improvement initiatives
• Led the design, implementation, and optimization of peer chart review processes to enhance program effectiveness and efficiency
• Developed and standardized data collection tools, improving data validity, reliability, and reporting accuracy
• Established and managed databases to support quality data tracking, analysis, and reporting across departments