System Director, Associate Counsel, Managed Care

Description

Summary :

The System Director, Associate Counsel, Managed Care provides legal services on matters relating to managed care contract negotiation, interpretation, management, and dispute resolution for hospitals, physicians and other healthcare providers in a healthcare system, including outpatient and ambulatory facilities. The responsibilities of this role include contract drafting and analysis, project management, and resolution of managed care issues arising in the ordinary course as well as in connection with changes in federal or state law or hospital or other healthcare facility operations, and mergers, acquisitions and joint ventures involving CHRISTUS hospitals and other healthcare providers. This attorney will report to a senior CHRISTUS attorney, and work directly with and support the work of the CHRISTUS Managed Care department, which is responsible for all Managed Care matters within this multi-state (Louisiana, New Mexico, Texas), nonprofit healthcare system. This attorney also works collaboratively with other members of the Legal department and leaders of other System departments, including Revenue Cycle and Business Development, and must be able to interact effectively with all levels of staff and management.

This attorney should have a strong working knowledge and understanding of the regulatory framework of health plans, including applicable federal and state laws, and general familiarity with the operations and regulation of hospitals and other healthcare facilities and providers. Health plan-related knowledge must include experience with and understanding of operational and regulatory issues relating to internal and external claims reviews, network adequacy requirements, Internal Review Organizations (IROs), standard commercial payor contracting provisions, Medicare Advantage, Medicare secondary payment rules, Accountable Care Organizations (ACOs), the Affordable Care Act, and the No Surprises Act. Understanding of health care operational and regulatory matters must include those relating to general billing and reimbursement, electronic medical records (EMRs), HIPAA privacy and security regulations, the Anti-Kickback Statute, the Stark Law, beneficiary inducement prohibitions, and the False Claims Act.

The System Director, Associate Counsel, Managed Care must be able to : analyze, draft and negotiate key language terms of managed care contracts; assist in the development of managed care contracting strategies; conduct accurate and timely due diligence review of managed care contracts for proposed transactions; analyze and clearly explain the implications of new and existing laws and proposed managed care contracting provisions to Managed Care and other business leaders; and actively oversee and participate in strategic analysis for managed care arbitration and litigation.

This attorney must also have strong drafting skills, effective oral and written communication skills, and solid research and analysis abilities.

This position requires the ability to work at the level (depending on years of experience) of a law firm mid-level to senior associate. The attorney should demonstrate initiative, sound judgment and clear thinking, with a strong commitment to continuous learning and providing timely and effective client service. This attorney must have the ability to provide clear legal guidance and information through formal and informal communications. This position requires the ability to work collaboratively with leaders and staff at both the System and regional level, as well as outside counsel and experts.

This System Director, Associate Counsel reports to a designated Vice President within the Legal department and has a dotted-line relationship with the System Vice President, Chief Managed Care Officer. This attorney will also work closely with other members of the Managed Care team.

Education :

Juris Doctor degree from a U.S. accredited law school

Experience :

Five or more years of experience primarily providing legal services in connection with managed care matters, in a law firm or in-house counsel setting.

Demonstrated history of activity designed to achieve continuous professional growth.

Skills :

Solid knowledge and understanding of federal and state laws and regulations relating to commercial and governmental health insurers and plans, including contracts, claims, reimbursement, denials, networks, arbitration, and litigation.

General knowledge of healthcare-related laws and regulations applicable to contracts and transactions involving nonprofit healthcare systems, hospitals, ancillary and ambulatory facilities, physicians, and other healthcare providers and functions, such as the Stark, Anti-Kickback, HIPAA, tax-exemption, and antitrust laws.

Strong drafting, writing and analytical skills.

Strong attention to detail, with ability to summarize key issues clearly and succinctly.

High commitment to provide responsive and timely service.

Excellent interpersonal and communications skills.

Ability to quickly grasp new concepts, information, and nuances in connection with legal and related operational issues.

Ability to efficiently analyze factual circumstances and apply relevant legal principles within a real-world context.

Ability to effectively communicate and work collaboratively with internal clients and other attorneys and functional leaders across the System.