Deputy General Counsel-Litigation & Hearings

Job Summary:

The Deputy General Counsel I is responsible for assisting the General Counsel of CareSource and providing day-to-day legal advice to ensure compliance with applicable laws, regulations, policy, Medicare, Medicaid, and accreditation standard.

Essential Functions:

Provide legal advice on a wide range of corporate matters
Represent CareSource in structuring and negotiating corporate transactions such as mergers, acquisitions, affiliations, and joint ventures
Draft and negotiate managed care contracts, including provider agreements, health network contracts, administrative services agreements, management agreements, vendor contracts, and reinsurance agreements; and work towards settlement in contract disputes towards settlement in contract disputes
Interface with regulators, including providing assistance in drafting regulatory filings and communications for submission to regulators and attending meetings with regulators
Conduct legal research and render opinions on legal matters, such as fraud and abuse issues, privacy tax-exemption matters, legislation, and insurance regulations
Assist with and provide counsel to senior leadership in connection with both internal and external member appeals related to benefit coverage and internal and external provider appeals related to payment and audits (including representation of clients at administrative law judge proceedings)
Provide counsel on provider credentialing matters and represent CareSource at fair hearings
Give presentations to governing boards, management committees, and workgroups
Draft policies and procedures needed by CareSource to ensure that business operations are compliant with internal and external requirements
Advise CareSource as to regulatory reporting requirements (data bank, state licensing board, Office of Inspector General, Centers for Medicaid and Medicaid Services, Medicaid agency, and department of insurance, etc.
Prepare and review contracts and/or agreements between the company and outside organizations with heavy emphasis on IT related contracts
Provide legal advice on a wide range of topics related to health care law such as, HIPAA, regulatory compliance, Medicaid and Medicare issues and privacy rights
Interact with management team as well as with external representatives of the legal system, regulatory agencies, governmental entities and others
Perform due diligence on any new state operations, including qualifying each company in a new state for business operations
Speak on legal related topics on a quarterly basis
Perform any other job duties as requested

Education and Experience:

Completion of a Juris Doctorate degree program from an accredited college/university is required
Minimum of five (5) years health care experience, in managed care and/or related health care industry is required
Experience with Medicaid/Medicare regulations is required

Competencies, Knowledge and Skills:

Advanced expertise in contract drafting, review, and negotiations
Advanced expertise in health care/managed care regulatory environment
Top analytic, research and organizational skills
Advanced Microsoft Office skills, including Word
Broad internet research skills
Excellent written and oral communications skills
Strong customer service and team orientation
Excellent time/project management and prioritization skills
Ability to excel in fluid, dynamic environment

Licensure and Certification:

Must be a member in good standing of a State Bar
Current, unrestricted license to practice law is required
Working Conditions:

General office environment; may be required to sit or stand for extended periods of time

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