Clinical ValueBased Consultant- RN

SEP Summit Medical Group, Inc.; United States; Hybrid; USD 85,000 - 110,000; Full time

Benefits offered by this job

Remote work eligibility after training

Paid Time Off

Medical, dental, vision

Job summary

St. Elizabeth Physicians seeks a Clinical Value-Based Consultant (CVBC) to drive contract performance and clinical value initiatives within a health system network.

You will collaborate with VBP leaders, providers and clinical teams to monitor metrics, implement interventions, and coordinate care opportunities under value-based agreements. The role emphasizes clinical judgment, data interpretation, and interdepartmental collaboration to improve quality and utilization outcomes.

Qualifications

• RN licensure with multistate (NLC) license; associate degree.
• Experience in healthcare delivery with direct physician/patient contact (2–5 years).
• Population health, quality, or clinical management experience preferred.

Responsibilities

• Analyze contract data to identify trends and changes.
• Lead data-driven interventions for value-based contracts.
• Coordinate with leaders and frontline staff on measurement plans & opportunities.
• Support training and development on value-based metrics and contracts.
• Communicate effectively with payors and internal teams.

Skills

Verbal & written comms

Analytical skills

Attention to detail

Team coordination

Education

Associate degree RN licensure

Tools

EPIC

Excel

PowerPoint

Outlook

Job description

Job Type: Regular Scheduled Hours: 40

Reports to the Manager of Value Based Performance, the Clinical Value-Based Consultant (CVBC) will work directly with Value Based Performance (VBP) manager and director on all set organizational quality and utilization goals as it relates to value-based contracts. The VBC is responsible for working collaboratively with stakeholders at all levels of the organization including: executive leadership, provider practices, Clinical Transformation departments and other external organization leadership. The Value Based Consultant is responsible for managing assigned payor contracts by tracking, trending, analyzing, and implementing interventions based on payor and internal data. The VBC may also outreach directly to SEP providers, patients and/or caregivers regarding identified care opportunities. The VBC serves as a liaison between the healthcare system and payor representatives, working collaboratively to support the organization’s success with value-based contracts. The VBC will lead and/or contribute to organizational projects that require value-based input.

The Clinical Valued Based Consultant works collaboratively and uses their clinical skills and judgement for the following:

1. Evaluate processes for clinical appropriateness while ensuring they meet value-based contract requirements.
2. Referring patients for additional resources such as: care coordination, pharmacy, and/or social work.
3. Serves as a clinical resource to non-clinical associates. They will provide clinical guidance as needed.
4. Assists with orientation and onboarding in the Value Based Performance department.

Job Description

Clinical ValueBased Consultant Tier I Job Code 11170

Benefits

• Remote Work Eligible after training (Must live within 1 hour from Erlanger KY to be considered) equipment provided
• No Nights, Holidays, or Weekends.
• Paid Time Off
• Medical, Dental, and Vision
• 403b with Match
• Opportunity for Career Growth

Education

Associate's degree with RN Licensure

Years of Experience

Minimum: 2-5 years in a healthcare delivery system, including experience with direct physician and patient contact. Previous experience in Population Health, Quality, or Clinical Management preferred.

Licenses and Certifications

Active, unencumbered multistate (compact) RN nursing license issued by a Nurse Licensure Compact (NLC) state, specifically Kentucky, Indiana or Ohio. Must have a valid driver’s license for travel between office sites (if applicable)

Duties and Responsibilities

• Analyze contract data to identify trends and changes.
• Prepare and present verbal and formal updates regarding barriers.
• Support appropriate stakeholders with data needs as it relates to assigned value-based contracts.
• Implements interventions as deemed appropriate based on findings in data reviewed.
• Partners with and facilitates communication with leaders, stakeholders and frontline staff to develop, implement and maintain a successful partnership as it relates to assigned value-based contract metrics.
• Examine current organizational workflows and data to advise appropriate stakeholders on opportunities for improvement as it relates to value-based contract expectations and incentives.
• Attention to detail, organizational skills, effective communication, flexibility and adaptability to change, and a great attitude, are critical.
• Provides leadership and coordination support to any area in the organization that requires information or education related to value-based contracts and opportunities.
• May develop, edit and share reports and/or presentations intended to inform stakeholders.
• Supports and/or leads organizational or departmental projects that require value-based input.
• Will work collaboratively to develop effective measurement plans in support of value-based metrics.
• May track and manage value-based performance for assigned contract and identify areas of opportunity and success.
• Works collaboratively with payors to ensure routine delivery of contract data.
• Will perform routine chart audits to identify closed care gaps and area of opportunity with organization and contract to improve performance with quality/utilization metrics.
• initiate telephonic and/or electronic outreach with patient/family to communicate care gap closure opportunities.
• Assist in scheduling appointments and placing clinical orders based on set protocols.
• Completes Medication Reviews or Annual Wellness Visits as directed by organizational leadership. (RN only)
• Identify appropriate internal resources and place referrals for high risk/high utilization patients as needed.
• Documents contacts accurately and in a timely manner.
• Maintain an effective working relationship with team members, members of the medical practice (clinicians, administrators, office staff, etc.), payor representatives, and leadership.
• Communicates effectively with co-workers and healthcare team to support continuity of care and service.
• Resolve issues or problems in a direct, open, and constructive manner.
• Honors the dignity of every individual in all interactions.
• Duties and responsibilities are completed in a timely and accurate manner.
• Assist with training of new employees and staff regarding value-based metrics and contracts.
• Contributes to development of educational materials as needed.
• Share new knowledge with team and collaborate with leadership to update workflows if necessary.
• Attends routine payor, departmental, or organizational meetings.
• Must have flexibility with schedule to ensure attendance and participation to necessary meetings.
• Performs other duties as needed.

Required Skills and Knowledge

Excellent verbal and written communication skills. Analytical Skills Skills in establishing and maintaining effective working relations with physicians, office employees, and patients. Self-directed and performs duties willingly and proactively. Continuously strives for excellence. Should attain working knowledge electronic health record applications. Previous use of EPIC preferred. Ability to manage and prioritize multiple tasks. Positive Attitude Flexibility and adaptability to change. Must work carefully and precisely with attention to detail. Requires proficient computer skills especially Word, Excel, PowerPoint and Outlook. Demonstrated ability to work successfully in a team-based decision-making culture. Demonstrated ability to work independently resulting in effective outcomes and on-time performance. Experience in planning and coordinating multi-disciplinary communications strategies, strategic initiatives, and events. Must respond and follow through to requests from customers promptly. Must work carefully and precisely with attention to detail. Must utilize resources wisely. Performs duties willingly and with initiative. Shares necessary information so co-workers can do the same. Cooperates with other departments and work groups.

FLSA Status

Exempt Right Career. Right Here.

If you have a passion for taking care of the community and are interested in Healthcare, you will take pride in the level of care we provide at St. Elizabeth. We take care of patients and each other.

St. Elizabeth Physicians is an equal opportunity employer and will not discriminate on the basis of race, color, sex, religion, national origin, ancestry, disability, age or any other characteristic that is protected by state or federal law.

St. Elizabeth Healthcare is one of the oldest, largest and most respected medical providers in the Northern Kentucky, southeastern Indiana and Greater Cincinnati region. Together with St. Elizabeth Physicians, the affiliated multi-specialty physician and advanced practice provider organization, we are transforming healthcare through innovative treatments, cutting-edge technology and a heart for our community. We’re right here, sharing one mission: to improve the health of the people we serve.