Assistant General Counsel for Health Plan Operations
J
JobgetherHealthcare
United StatesFull-TimeSenior
Salary$175,000 - $225,000
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Job Details
- Experience
- 8-10 years
- Required Skills
- Risk Management
Requirements
- Active license to practice law in at least one U.S. state.
- 8-10 years of legal experience, including 2-4 years of in-house counsel experience.
- Prior experience working within a health plan environment.
- Strong knowledge of healthcare regulatory requirements related to health plan operations, including claims, provider contracting, and delegation.
- Ability to analyze legal issues through a business-focused lens.
- Proven ability to manage complex legal matters and meet regulatory deadlines.
- Excellent communication and relationship-building skills.
- Proactive and adaptable mindset.
- Strong organizational skills and ability to manage multiple priorities.
- Experience supporting Medicare Advantage plans (highly desirable).
Responsibilities
- Provide practical legal counsel across health plan operations, including claims administration, payment integrity, appeals, and related regulatory requirements.
- Advise network development and management teams on provider contracting, provider relationships, credentialing, and operational legal matters.
- Partner with compliance teams to support adherence to state and federal healthcare laws, regulations, and health plan requirements.
- Provide legal guidance on delegated arrangements involving third-party administrators, pharmacy benefit managers, behavioral health providers, and other external partners.
- Support delegated entity oversight programs, including compliance monitoring, remediation efforts, and regulatory reporting obligations.
- Monitor evolving healthcare regulations and translate complex legal requirements into actionable recommendations for operational and clinical teams.
- Assist with regulatory examinations, audits, inquiries, and interactions with state insurance departments and other regulatory agencies.
- Advise on the legally compliant implementation of clinical programs, quality initiatives, utilization management processes, and strategic business decisions.
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