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General Counsel
Consulting
provided
exceptional
service in helping
my organization
recruit for a hard
to fill position.
They did extensive
work on the front
end to understand
our needs and
our culture and
began referring
highly qualified
candidates almost
immediately.

Melinda Burrows
Deputy General Counsel
- Litigation and
Compliance, Progress
Energy Service Company
LLC

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Counsel Jobs > Senior Health Counsel, Commercial and Government Markets Job in Pennsylvania > Senior Health Counsel, Commercial and Government Markets

In House Legal Job Listings

YOUR WINDOW TO A WORLD OF OPPORTUNITIES

Senior Health Counsel, Commercial and Government Markets

Refer job# OWTP142885

Senior Health Counsel, Commercial and Government Markets The candidate will align and build out disciplined and coordinated efforts around interpretation and application of regulatory guidance on product and network initiatives and risk management requirements. Will drive involvement and partner closely with business area attorneys, product, marketing, distribution, analytics, and technology leaders across the company to identify insights, highlight problems and provide critical input into key decisions to execute on the Companys strategy. Provides legal support for Guardian's Commercial & Government Markets (C&GM) division, focusing primarily on matters related to group commercial and government dental and vision insurance with an emphasis on government programs. Specific support expertise includes counseling of internal clients, coordinating work performed by outside counsel, negotiating and drafting contracts, including provider and Medicaid/Medicare agreements, providing regulatory advice with attention to health matters, and ensuring compliance with Company guidelines. Provide crisp, pragmatic real time advice on business matters, to internal business clients as requested on agreement terms, regulatory or legal requirements, company policies, processes, approval requirements, and legal issues. Collaborate with and facilitate cross-team decision-making among the network team, product team, legal team, operations and other various internal departments and clients. Coordinate with the business stakeholders to ensure consistency of approach and best practices for network development, credentialing, and client arrangements, where appropriate. Review and prepare commercial agreements, provider agreements, network leasing agreements, MCO agreements and other documents, counseling clients on related regulatory and other legal issues. Ensuring companys compliance with relevant federal and state laws, including Health Information Portability and Accountability Act (HIPAA) and all other relevant federal and state laws. Identifying and providing counsel on a range of legal issues related to the government and commercial product development and distribution activities of C&GM, including the collection, use, sharing and protection of regulated information under relevant federal and state law. Providing analysis and legal counsel related to the permissibility of new business initiatives as it relates to federal and state insurance matters in supporting dental and vision products. Ensure processes are in place for a robust governance program that includes company policies, procedures, and guidance covering all legal matters in support of federal and state laws. Enhancing healthcare law education and awareness across the organization. Enhancing effective systems for monitoring, auditing, and measuring the effectiveness of the Healthcare law programs to identify successes, potential areas of vulnerability, risks and areas for further improvement. Where required, develop a mitigation process to protect the company and its businesses and functions and ensure compliance to protect business and reputational risk in the collaboration with the Compliance teams. Working closely with internal Privacy Counsel, ensuring the implementation, maintenance and revision of, and adherence to, the organization's policies around Protected Health Information (PHI) and, generally, other forms of regulated privacy and confidential information, as necessary to comply with federal and state laws and the company's internal privacy policies and practices. Continuing knowledge of current healthcare regulations, including contractual and operational issues management involving HIPAA and other regulations and laws affecting C&GM. Developing external contacts and participating in professional organizations that will provide benchmarks for healthcare law internally and enhance the understanding of the external environment to anticipate new trends and developments in the field. The candidate must have 10+ years legal experience in the various commercial disciplines gained in any combination of a major law firm and/or corporate in-house insurance where healthcare law has been the primary focus. Should have J.D. Degree from a national law school with excellent academic performance demonstrated. Prior admission to at least on State Bar and admission to NY bar within one year of hire or NY in-house limited license required. Must have experience interfacing with Executive Management. Must have experience with developing and implementing commercially-aligned legal counsel, including interaction with executives, internal and external stakeholders, outside counsel and regulatory personnel. Must have knowledge of commercial and government healthcare laws and regulations. Must have experience drafting contracts, including business associate agreements. Must have experience working with state insurance departments on ranging legal matters. Must have experience in privacy compliance and data security including policy and corporate and regulatory knowledge.

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