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Years of Experience
Date Last Verified
ProfileAssociate General Counsel The candidate responsibilities will include providing legal counsel and expertise to company’s Clinical Services Organization, which is 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 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.
Qualification and Experience
The candidate should have Juris Doctorate degree. Must have 5+ years of healthcare or managed care legal experience. Should have knowledge of U.S., state contract, corporate health care and regulatory law. Must have understanding of health care benefit coverage and medical policy development. Professional clinical licensure is preferred. Strong understanding of health insurance and/or managed care industry is desired. Should have preferable experience with regulatory agencies and administrative experience with State insurance regulations, DOL claims regulations and HIPAA . Must have demonstrated understanding of business problems related to assigned legal projects. Should have eell-developed written and verbal communications skills. Must have excellent presentation skills. Should have ability to evaluate and determine appropriate legal course of action to meet business unit needs. Must have ability to build and maintain rapport with superiors, peers, subordinates, and external company contacts.