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Carrot Peelers, Sales, Personality and Your Job Search
Public Interest
Attorney
Health Care
Litigation - Whistleblower - CFTC
Min 12 yrs required
Associate Counsel The candidate will provide legal support and counsel to firm Health Plan, firm Indemnity Insurance Company and firm Quality Options, Inc. (collectively,â€Health Planâ€) within an integrated healthcare delivery system. Specifically, provides legal services in support of Health Plan’s commercial HMO/PPO/POS, self-funded, Medicare Advantage and Medicaid operations and other activities, drawing on operational, transactional and regulatory managed care expertise. Will work independently and reports directly to the Health Plan’s General Counsel. Analyzes a broad range of complex laws and regulations affecting Health Plan (including, but not limited to, ERISA, HIPAA, Medicare Advantage rules and regulations and federal and state insurance and privacy law), and prepares legal memoranda and opinions of counsel, as needed, regarding the same. Provides counsel to Health Plan management regarding legal/regulatory issues, under the direction of Health Plan’s General Counsel, and communicates in a timely and effective manner with Health Plan management and staff. Drafts and reviews, or supervises drafting and review of, contracts and related documents for procurement of goods and services, confidentiality of proprietary information, leases of space and equipment, software licenses, and electronic transmission of healthcare data, provider, marketing and distribution contracts, under direction of General Counsel. Drafts and reviews, or supervises drafting and review of, benefit related documents for group and individual health insurance products and ensures regulatory compliance of the same. Represent Health Plan in administrative hearings and other matters, including audits and reviews involving Centers for Medicare and Medicaid Services, Pennsylvania Department of Human Services, state insurance departments, health departments and other federal and state regulatory agencies. Administers corporate contract management procedure and serves as a resource for Health Plan management on contracts and Health Plan policy related to contracts. Works with all operational areas of Health Plan and serves as a resource for the legal component of operational questions. Maintain effective, cooperative working relationships with Health Plan staff and management as well as external contacts, such as outside counsel, opposing counsel and regulators. Researches and responds to inquiries about the legal requirements for obtaining and maintaining licensure for Health Plan business, plans and operations, as well as inquiries and investigations from regulatory oversight agencies. Interacts with, and relates to, firm Health System Legal Services Department as necessary.
Qualification and Experience
The candidate must have a Juris Doctorate Degree from an accredited law school. Should have active license to practice law in Pennsylvania or member of other State Bar with Pennsylvania membership required within 12 months of date of hire. Experience of 5+ years in areas of health insurance, managed care, and/or healthcare is required. Skills in healthcare and managed care transactional and regulatory work is needed. Demonstrated Governmental healthcare program experience is preferred.
Job ID : 23128
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