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Years of Experience
ProfileAssociate General Counsel The candidate will be responsible for providing legal counsel and expertise. Will be also responsible for clinical matters across Medicare, Medicaid and Commercial lines of business, including medical management, quality of care, health plan accreditation, provider credentialing and clinical performance measurement. Will frequently interact with senior company leaders and/or outside counsel on complex issues having impact across Group organization entities. Primary Responsibilities: Providing legal counsel on the development and implementation of national medical and drug policies and administrative protocols across the enterprise. Providing legal support for quality and affordability programs. Supporting benefit interpretation process across the lines of business. Assisting in the support of clinical pilot programs across the enterprise. Coordinating with and supporting Regulatory Affairs and Compliance in responding to regulatory inquiries; assisting with development and deployment of regulatory outreach strategies. Handling complex legal projects. Evaluating and determining appropriate legal course of action to meet business unit needs Guiding, training and assisting others on legal issues; coordinating legal reviews with other subject matter experts within Legal, Regulatory Affairs and Compliance departments. Must have JD degree and 5+ years of healthcare or managed care legal experience. Should have knowledge of U.S., state contract, corporate health care and regulatory law Understanding of health care benefit coverage and medical policy development. Experience with regulatory agencies and administrative experience with State insurance regulations, DOL claims regulations and HIPAA Soft is essential.