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Senior Director, Legal Counsel-Dispute Resolution and Government Programs
Refer job# OHWY169670
 
Senior Director, Legal Counsel-Dispute Resolution and Government Programs Duties: The candidate will provide strategic advice and counsel on a broad range of health care disputes and issues, with a particular focus on health care litigation, provider arbitration, regulatory enforcement actions, subpoenas, and investigations related to government programs (Medicare and Medi-Cal). The ACG will be the primary litigation attorney supporting's and Promise Health Plan's government programs lines of business, but will also manage commercial disputes. The AGC will report to the Vice President, Deputy General Counsel, and Litigation. The Law Department partners with the company's business leaders to embrace legal and ethical behavior in the achievement of the company's mission. The Litigation Group is highly regarded within the company and respected by management. It is comprised of top-tier, analytical, ethical, collaborative, and intelligent attorneys, paralegals, litigation specialists, fraud investigators, and administrative support staff. The AGC must comfortably adapt to change, lead with influence, demonstrate strong business acumen, master new responsibilities, effectively advise business clients in a dynamic business and legal environment, and possess a strong drive for excellence. Retain, oversee, and manage the work of outside counsel and ensure adherence to the outside counsel budget. Recommend operational plans and strategies that directly impact the achievement of overall results for multiple departments and company-wide results, profitability, and/or public image of the organization. Coordinate all litigation and investigation-related legal services required by Promise Health Plan. Establish legal policy and standards for the enterprise, and for the business and functional units served by the AGC. Manage the paralegal assigned to government programs litigation, arbitration, subpoenas, and regulatory enforcement matters. Work collaboratively with other attorneys, paralegals, and litigation specialists specializing in commercial disputes. Provide guidance and training to's highly capable and valued legal support professionals. Defend against litigation, arbitrations, investigations, subpoena response, and regulatory enforcement matters, in some cases directly, and in others, by supervising the work of outside legal counsel. Pursue litigation and recovery. Engage with government agencies in connection with subpoenas, enforcement actions, and investigatory demands. Partner with internal clients and paralegals to respond to discovery requests and investigatory demands. Provide timely, actionable advice and counsel to internal clients, enabling them to achieve their goals within a prudent range of legal risk, offering particular expertise in risks associated with government programs (Medicare, Medi-Cal). Handle other duties, as assigned.

Qualifications: A Juris doctorate degree is required; superior academic credentials from a top-tier law school are strongly preferred. Must have 10 years of experience providing legal advice on relevant areas of the law (e.g., corporate, privacy, health care regulatory, litigation, contracts, et al) at a top law firm or in-house corporate law department. Should have 8 years of litigation experience, at least 5 of which include recent experience defending health plans, health insurers, or HMOs in litigation, arbitration, government investigations, subpoena response, and other formal or informal disputes. A combination of law firm and in-house experience is preferred. An active member of the California State Bar. Possess strong knowledge and recent experience, providing actionable legal advice to business clients related to the Knox-Keene Act, False Claims Act, Stark laws, Medicare Advantage, Medicare Supplement, and Medi-Cal. Demonstrated experience with contracted and non-contracted provider payment disputes. Self-motivated, enthusiastic, ethical, collaborative, and hard-working. A successful candidate will have a roll up your sleeves style and the ability to partner and effectively communicate with employees at all levels of the organization. Requires strong written and oral communication skills, analytical skills, intellectual curiosity, interest in diving into the facts, and the ability to meaningfully communicate with business clients at all levels of the organization regarding complex legal matters.
 
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