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
