Joe Nalley.
Operator / Founder / Payer Exec / Builder
I've sat in both chairs at the payer-provider table. Built a health system from scratch, scaled to $30M, took it through acquisition. Sold a billing platform that returned $9.2M in its first six months of full deployment. Now I run specialty risk portfolios inside Carelon (Elevance Health) while building governance products independently for gaps the industry has left open.
The payer role makes me a better founder.
The founding makes me a better executive.
The gap I'm building for is visible from both seats.
The founding makes me a better executive.
The gap I'm building for is visible from both seats.
$30M+
Exit · Health System
$9.2M
Returned · First 6 Months
200K+
Patients Served · Career
65,234
Evidence Cohort · NIH-Validated
45M+
Members · Specialty Risk
Experience
Section 01 / 062024 — Present
01 /
01 /
Staff Vice President, Specialty Risk Product Strategy
Carelon — Health Services arm of Elevance Health · Louisville, KY
- Lead product strategy across six integrated specialty risk portfolios. 45M+ total plan members; 30M managed lives across specialty medical spend covering six high-acuity specialty risk books.
- Direct a product team of directors, analysts, PMs, and product owners. Work across Finance, Actuarial, Legal, Compliance, IT, and Provider Partnerships.
- Built Risk Playbook 2.0: defined the RACI, commercialization process, and phase-gating framework for bringing risk products to external market. Sole author, built from 50+ internal interviews into an interactive governance tool. Now the operating standard for risk product commercialization across the subsidiary.
- Drove the MSK risk expansion business case ($48M+ modeled operating gain, three-year horizon). Found and defined the operating model gaps blocking two additional programs from reaching market. Both now in active remediation.
- Built the blueprint for a member-intelligence hub connecting clinical, claims, and risk data across all specialty books. One coordinated record instead of three separate programs for a member's orthopedic episode, chronic condition, and behavioral health needs.
2025 — Present
02 /
02 /
Founder & CEO
- Built the governance layer for what happens after authorization. Cadence governs specialty pharmacy continuation. Caliber verifies high-cost claims before payment. Curated routes behavioral health episodes. Seven products and four tools under the Corridor umbrella, all built as sole contributor. Full portfolio at joe-nalley.com.
- Authored the Cadence Governance Standard (CGS v1.1): 8-section clinical framework defining when, how, and by whom a continuation therapy gets reassessed. 7 required triggers. Open standard, published for industry adoption.
- Three locked cohorts totaling 65,234 patients. Flag rates of 25–29.1% converge across all three populations, anchored by the 30,734-patient NIH All of Us study. Modeled first-cycle savings value of $14.3M covering four drug classes.
- Built the platform architecture, pricing models, and every site. 11,000+ lines on Cadence alone, single-file, no framework. Pharmacy Times article published (April 2026). Manuscripts submitted to Health Affairs and AJMC.
2023 — 2025
03 /
03 /
Founder
ClearBill (acquired) · Remote
- Built a real-time billing integrity platform that audits claims before they reach the payer. AI + human QA layer between clinical delivery and financial accountability. Catches errors, overcharges, and code mismatches at the source.
- Pilot: 30K patients, 125K+ claims, 61% denial reduction, ~$9.2M returned in its first six months of full deployment. B2C-to-B2B platform with payer PEPM revenue model. Acquired (confidential). Stayed on as CEO through integration.
2012 — 2025
04 /
04 /
Founder & CEO
GetWell Health System / North Clark / Kentucky Recovery / KMHC · KY, IN, GA, TX
- Founded Kentucky Mental Health Care (2012). Scaled to a 13-location health system across four states with 250+ employees and $30M+ in annual revenue at time of sale.
- Launched Kentucky Recovery (2018): state and federally licensed narcotic treatment program and SUD operation. Statewide coverage, 15,000+ patients per year.
- Established GetWell Health System, North Clark Community Hospital, and North Clark Medical Group (2021). Built a new regional hospital from the ground up with primary care, imaging, surgery, cardiology, neurology, and a full diagnostic lab.
- Led the full health system through acquisition (confidential). Stayed on as CEO for 3.5 years post-acquisition. Diligence, transition planning, and post-close integration. Full P&L responsibility, dozens of payer contracts covering Medicaid, commercial, and Medicare lines. 200,000+ patients served combined at time of sale.
2007 — 2012
05 /
05 /
Founder
Jing Masters (sold) · Two locations + e-commerce
First company. Traditional Chinese herbal medicine: two retail locations and the e-commerce store that made most of the money — tinctures, blends, single-herb extracts. Built and ran the online storefront. Sold in 2012, the same year Kentucky Mental Health Care was founded.
Education
Section 02 / 06M.S.Applied Behavior Analysis — Northeastern University
B.S.Organizational Leadership and Development — University of Louisville
Credentials
Section 03 / 06DEALicensed — narcotic treatment programs
JCAHOAccredited — hospital + behavioral health
SAMHSACertified — opioid treatment programs
LicensureMulti-state clinical — KY, OH, GA, IN, TX
Advisory
Section 04 / 06CurrentThe Home Depot — Benefits strategy (Head of Benefits)
Publications
Section 05 / 06PublishedPharmacy Times — "The Missing Measure: Continuation Appropriateness in Managed Care" (April 2026)
SubmittedHealth Affairs, AJMC — manuscripts (commentary)
StudyNIH All of Us DURA study — 30,734 patients. Federal validation complete.
WritingField Notes — joe-nalley.com/field-notes.html
Open To
Section 06 / 06Product leadership. Healthcare operations. Venture partnership. EIR. Strategy and advisory for organizations that build, not ones that study building. Remote preferred. Relocation for the right thing.
Both Seats. One Layer.
© 2026 Joe Nalley
joe-nalley.com