Clinical Lead (Value Based Care)

Location: Hybrid - 3 days/week in Park Ridge, IL office or field-based as needed

Reports To: Director, Value-Based Care Operations

FLSA Status: Exempt

Position Overview

The Clinical Lead, Value-Based Care is a senior clinical leadership role responsible for guiding the clinical strategy, protocol development, and provider education that underpin Vitae Health Systems' value-based care programs — including the organization's LEAD ACO and related CMS initiatives. This role reports to the Director, Value-Based Care Operations and serves as the clinical authority for VBC program execution.

This individual will work in close partnership with the SVP of Primary Care Clinical Services, who leads clinical governance for the fee-for-service business. While the SVP owns clinical standards across the broader primary care service line, the Clinical Lead, Value-Based Care operates as a dedicated clinical leader focused exclusively on VBC program performance, population health strategy, and cost of care management for the high-needs populations Vitae serves.

The ideal candidate is a licensed Nurse Practitioner with experience in value-based care models, population health, and clinical quality improvement who can bridge the gap between data-driven performance insights and frontline clinical behavior change.

Key Responsibilities

VBC Clinical Strategy & Protocol Development

• Serve as the primary clinical leader for Vitae's value-based care programs, including the LEAD ACO, providing strategic direction on clinical protocols and care management approaches.

• Develop, refine, and maintain evidence-based clinical protocols designed to improve quality outcomes, reduce unnecessary utilization, and manage total cost of care for high-needs patient populations.

• Partner with the SVP of Primary Care Clinical Services to ensure VBC clinical protocols are integrated with — and not duplicative of — enterprise-wide clinical standards.

• Lead clinical input into LEAD ACO program design, including care gap closure strategies, chronic disease management protocols, and transitions of care frameworks.

• Stay current on CMS policy changes, LEAD ACO program requirements, and emerging value-based care models; translate program updates into clinical guidance for internal teams and providers.

Provider Education & Clinical Engagement

• Design and deliver VBC-specific clinical education programs for primary care providers, including training on ACO quality metrics, documentation requirements, risk adjustment, and care coordination expectations.

• Serve as a trusted clinical resource and educator for providers navigating the shift from fee-for-service to value-based care models.

• Partner with Operations Managers and the Director, Value-Based Care Operations to identify providers or markets where additional clinical education or support is needed.

• Facilitate regular clinical updates, case reviews, and learning sessions to build VBC literacy and clinical engagement across the provider network.

• Support onboarding of new providers by ensuring VBC clinical expectations, protocols, and documentation standards are clearly communicated from day one.

Cost of Care Management & Utilization Oversight

• Monitor high-spend cost of care trends across the attributed patient population, identifying clinical drivers of excess utilization and recommending targeted interventions.

• Partner with the data and analytics team to review utilization reports, claims data, and population health dashboards; translate findings into clinically actionable recommendations.

• Lead clinical review of high-utilization patients, including those with frequent ED visits, avoidable admissions, or high pharmacy spend, and work with care teams to implement cost-effective care plans.

• Develop and oversee care management protocols targeting the highest-risk, highest-cost patients in the attributed population — with particular focus on the complex, high-needs populations Vitae serves.

• Track performance against total cost of care benchmarks and LEAD ACO financial targets; escalate clinical risks and recommend course corrections to VBC leadership.

Quality & Performance Improvement

• Provide clinical oversight of VBC quality metrics including HEDIS measures, AWVs, care gap closure rates, and other ACO quality benchmarks.

• Partner with the Director, Value-Based Care Operations to develop and execute quality improvement plans when performance gaps are identified.

• Conduct clinical audits and chart reviews to assess documentation quality, care plan adherence, and protocol compliance.

• Serve as a clinical liaison to CMS, convener partners, and external stakeholders as needed for program oversight and reporting purposes.

Cross-Functional Clinical Partnership

• Collaborate closely with the SVP of Primary Care Clinical Services to ensure alignment on clinical priorities, avoiding duplication and maintaining a unified clinical voice across the organization.

• Engage with the VBC data and analytics team to ensure clinical insights are incorporated into reporting frameworks and population health tools.

• Partner with Compliance to ensure clinical protocols, documentation practices, and care delivery align with CMS program requirements and regulatory standards.

• Support the Growth team with clinical input on new market expansion, facility partner conversations, and ACO attribution strategy.

Requirements

Required

• Active Nurse Practitioner (NP) licensure; board certification required (FNP, AGNP, or equivalent).

• Minimum of five (5) years of clinical practice experience, with at least two (2) years in a value-based care, population health, or ACO-related role.

• Demonstrated knowledge of CMS value-based care models, including ACO structures, quality reporting requirements, and cost of care benchmarks.

• Experience developing or implementing clinical protocols, care management programs, or provider education curricula.

• Familiarity with claims data, utilization metrics, and population health analytics as tools for clinical decision-making.

• Strong clinical communication skills with the ability to engage and educate providers across a distributed network.

Preferred

• Direct experience with the LEAD ACO, REACH ACO, or similar CMS innovation model.

• Prior experience in a post-acute, skilled nursing, or high-needs population health setting.

• Familiarity with risk adjustment methodologies (HCC coding, RAF scores) and their clinical documentation implications.

• Experience working cross-functionally with operations, compliance, and data teams in a matrixed healthcare organization.