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Senior Corporate Counsel - Managed Care The candidate serves as a member of the Legal Department. Will be team member and integral part of the Managed Care and Physician Integration Groups, the functional division of the Legal Department that primarily supports company's payor contracting and population health activities (defined below). Reports to and performs services under the direction and supervision of the Vice President and Associate General Counsel - Physician Integration ( "AGC-Physician Integration" ) or his/her delegate. Provides quality legal services and effective legal counsel in support of company's population health activities, including managed care legal services for company's hospitals, physician medical groups, medical foundation, clinically integrated networks, accountable care organizations, risk services organizations, company's Limited Knox-Keene health plan (California) and other managed care and population health business operations ( "Population Health" ) described in this Position Description in a manner consistent with company's Mission and Core Values. Will have the following key duties, responsibilities and accountabilities: Negotiate enterprise-wide and local payor agreement language with all major health plans for company's California, Arizona and Nevada integrated delivery networks, which include hospitals, clinically integrated networks, physician medical groups, a California limited Knox-Keene health plan, and ancillary health care providers. Provide guidance in connection with strategic initiatives relating to company's integrated delivery networks, including developing new and innovative payment structures with third party payors, determining network composition, and direct-to-employer network delivery strategies. Represent company's Limited Knox-Keene Plan and other risk-bearing entities in California, Nevada and Arizona, including licensure applications, material modifications, regulatory compliance, network provider contracting and network development. Be the subject-matter expert for managed care and payor relations, including exhibiting a deep understanding of hospital-medical group risk sharing arrangements, managed care markets, and regulations applicable to health plans and other risk bearing organizations. In this regard, the Senior Counsel must work cooperatively with company attorneys serving other functional areas, such as the company Hospital Operations Group. Provide advice and guidance as the primary legal business partner for the company Managed Care Department and Population Health Department, including regulatory compliance advice and managing the fair market value process for certain arrangements, as needed. To oversee and manage litigation, administrative proceedings and other regulatory (including licensure and certification) proceedings or matters related to payor contracting and operations of the California limited Knox-Keene health plan, as requested or assigned from time to time, including the management of outside counsel engaged to represent company in litigation, proceedings or filings. To oversee, manage and work collaboratively on matters assigned to outside counsel engaged to represent or assist company, including review, direction and supervision of outside counsel's legal work. To participate on projects or matters related to the management and administration of the Legal Department as requested from time to time by the General Counsel ( "GC" ), the AGC-Physician Integration, and/or other AGCs. To supervise, direct, manage and work collaboratively with the paralegals, executive coordinators, and other non-attorney staff assigned to work regularly or on specific projects with the Senior Counsel consistent with company's Core Values. To travel throughout company as required to perform the duties and responsibilities of the Senior Counsel described in this Position Description. To personally develop and/or satisfy the Senior Counsel Legal Competencies accompanying this Position Description. To support the Legal Department proactively, both internally within the Legal Department and externally throughout company, in the course and scope of the performance of the Senior Counsel's duties and responsibilities. To communicate frequently with the AGC-Physician Integration on matters critical to the Senior Counsel's duties and responsibilities, the Legal Department and company generally. To maintain excellent relationships, work collaboratively and engage in regular communication with the GC, other AGCs, the Legal Department's other attorneys, paralegals, executive coordinators and other non-attorney staff. To (i) manifest a commitment to company's Mission and Core Values, (ii) act and demonstrate behavior consistent with the company's Core Values in fulfilling the duties and responsibilities described in this Position Description, and (iii) contribute to a positive working environment in the Legal Department for all employees.
Qualification and Experience
The candidate should have Juris Doctor or equivalent degree from a law school accredited by the American Bar Association. Admission to the State Bar of California (or eligibility under the Registered In-House Counsel provisions of the State Bar of California), and professional licensure in good standing without any instances of suspension, revocation, censure or other adverse events in any jurisdiction is needed. Must have excellence in academic achievement. Should have 7-15 years of legal work experience in a law firm and/or in-house legal department involving the performance of managed care legal services for health plans, hospitals, health systems, providers, health care delivery organizations, and/or integrated delivery systems. Experience with navigating complex and dynamic corporate organizations is needed. Must have demonstrated excellent working knowledge and primary focus of prior work experience in managed care (federal, state and local laws, rules and regulations), including third party payor laws, the California Knox-Keene Act, privacy requirements, the Stark law and federal Anti-Kickback statute, other healthcare fraud and abuse laws, federal and state antitrust laws, and other laws impacting hospital-payor relationsand physician-payor relations. Should have familiarity with California medical foundation (so-called 1206( l ) foundation) payor contracting and network building models. Must have good working knowledge of other substantive legal areas and issues related to managed care and health care generally, including health care business and corporate transactions, hospital/physician/payor transactions, joint ventures, and mergers, acquisitions and dispositions. Should have good working knowledge of the key operational and strategic issues and challenges currently affecting hospitals, health systems, providers, health care delivery organizations, and/or integrated delivery systems. Must have familiarity with or willingness to learn and understand the legal and operational issues unique to faith-based health care systems. Should have demonstrated ability to identify legal risks, apply relevant law and organizational policies, and develop effective strategies for resolving or responding to the issues or risks. Must have excellent written and verbal communication skills, including the communication of complex legal and compliance concepts in a clear, concise and practical manner. Demonstrated ability to work closely and maintain good working relationships with and relate well to highly driven, diverse executives and personalities in an attorney-client setting are needed.
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