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In House Legal Job Listings

YOUR WINDOW TO A WORLD OF OPPORTUNITIES
 
Welcome to the job listings section of General Counsel Consulting. We are constantly updating our jobs seven days a week. As a firm dedicated to in-house search and placement, our ability to forge strong relationships with top-rated companies around the world allows us to offer our candidates a breadth of opportunities we believe is unrivaled.
 
We are pleased that your assessment of options has led you to General Counsel Consulting, and we invite you to browse our website to learn more about our firm and the career opportunities we offer. If you would like to be considered for an in-house attorney position, feel free to submit your resume.
 
If you are an employer looking to hire an in-house counsel, please click here to contact us and submit your opening.
 
 

Health Care Counsel

Houston TX Health Care Counsel The candidate provides proactive legal advice and counsel on issues related to the dynamic firm group and supports the products and services incorporated within the firm book of business including but not limited to supporting providers in providing value-based care through provider engagement services. Will support the Business in addressing legal, operational and escalated regulatory compliance issues requiring legal intervention related to firm products and services, with a focus on problem solving and solution based advice; will assist with the review, analysis and editing of contract documents such as non-disclosure agreements, business associate agreements, management services agreements, practice transformation agreements, and administrative services agreements; will provide legal support to firm business regarding new market and product development and company strategy, organizational business projects and fulfillment of operational and strategic goals. Accountable for a working knowledge and expertise of state and federal laws and regulations pertaining to management of provider entities such as IPA s, CIN s and physician practices, laws and regulations related to provider incentive and gain sharing arrangements, state and federal requirements related to delegated entities and downstream provider networks, legal and regulatory requirements related to the creation and maintenance of clinically integrated networks, fully-insured and governmental product offerings, the Affordable Care Act, and federal and state privacy laws and regulations including the HIPAA Privacy and Security Rule. Collaborates with business, operational risk and compliance staff to identify known and potential regulatory, legal and business risks impacting firm operations. Assist with the interpretation of federal and state laws to assess impact on firm operations and strategy. Should preferably have 6-8 years corporate legal department or relevant law firm experience. Must have JD degree from accredited law school and Bar membership. Strong analytical skills are required. Familiarity with managed care products and (fully insured and governmental) downstream provider networks and regulatory requirements governing such environments is desired. Strong drafting and contract writing skills, developed negotiating skills and the ability to work with a high degree of independence with demonstrated results is needed. Strong experience in measuring and analyzing process as well as results, to identify opportunities for improvement is must. Legal 6 - 8 Full-time 2018-09-07

Health Care Counsel

Bloomfield CT Health Care Counsel The candidate provides proactive legal advice and counsel on issues related to the dynamic firm group and supports the products and services incorporated within the firm book of business including but not limited to supporting providers in providing value-based care through provider engagement services. Will support the Business in addressing legal, operational and escalated regulatory compliance issues requiring legal intervention related to firm products and services, with a focus on problem solving and solution based advice; will assist with the review, analysis and editing of contract documents such as non-disclosure agreements, business associate agreements, management services agreements, practice transformation agreements, and administrative services agreements; will provide legal support to firm business regarding new market and product development and company strategy, organizational business projects and fulfillment of operational and strategic goals. Accountable for a working knowledge and expertise of state and federal laws and regulations pertaining to management of provider entities such as IPA s, CIN s and physician practices, laws and regulations related to provider incentive and gain sharing arrangements, state and federal requirements related to delegated entities and downstream provider networks, legal and regulatory requirements related to the creation and maintenance of clinically integrated networks, fully-insured and governmental product offerings, the Affordable Care Act, and federal and state privacy laws and regulations including the HIPAA Privacy and Security Rule. Collaborates with business, operational risk and compliance staff to identify known and potential regulatory, legal and business risks impacting firm operations. Assist with the interpretation of federal and state laws to assess impact on firm operations and strategy. Should preferably have 6-8 years corporate legal department or relevant law firm experience. Must have JD degree from accredited law school and Bar membership. Strong analytical skills are required. Familiarity with managed care products and (fully insured and governmental) downstream provider networks and regulatory requirements governing such environments is desired. Strong drafting and contract writing skills, developed negotiating skills and the ability to work with a high degree of independence with demonstrated results is needed. Strong experience in measuring and analyzing process as well as results, to identify opportunities for improvement is must. Legal 6 - 8 Full-time 2018-09-07

Health Care Counsel

Philadelphia PA Health Care Counsel The candidate provides proactive legal advice and counsel on issues related to the dynamic firm group and supports the products and services incorporated within the firm book of business including but not limited to supporting providers in providing value-based care through provider engagement services. Will support the Business in addressing legal, operational and escalated regulatory compliance issues requiring legal intervention related to firm products and services, with a focus on problem solving and solution based advice; will assist with the review, analysis and editing of contract documents such as non-disclosure agreements, business associate agreements, management services agreements, practice transformation agreements, and administrative services agreements; will provide legal support to firm business regarding new market and product development and company strategy, organizational business projects and fulfillment of operational and strategic goals. Accountable for a working knowledge and expertise of state and federal laws and regulations pertaining to management of provider entities such as IPA s, CIN s and physician practices, laws and regulations related to provider incentive and gain sharing arrangements, state and federal requirements related to delegated entities and downstream provider networks, legal and regulatory requirements related to the creation and maintenance of clinically integrated networks, fully-insured and governmental product offerings, the Affordable Care Act, and federal and state privacy laws and regulations including the HIPAA Privacy and Security Rule. Collaborates with business, operational risk and compliance staff to identify known and potential regulatory, legal and business risks impacting firm operations. Assist with the interpretation of federal and state laws to assess impact on firm operations and strategy. Should preferably have 6-8 years corporate legal department or relevant law firm experience. Must have JD degree from accredited law school and Bar membership. Strong analytical skills are required. Familiarity with managed care products and (fully insured and governmental) downstream provider networks and regulatory requirements governing such environments is desired. Strong drafting and contract writing skills, developed negotiating skills and the ability to work with a high degree of independence with demonstrated results is needed. Strong experience in measuring and analyzing process as well as results, to identify opportunities for improvement is must. Legal 6 - 8 Full-time 2018-09-07

California - Hospital Health Plan Compliance Officer

Walnut Creek CA Hospital Health Plan Compliance Officer
The candidate will serve as the Hospital and Health Plan Compliance Officer, the Privacy Officer, and as a member of the Medical Center Leadership team. Will be responsible for the strategic development, implementation and evaluation of compliance management systems at the Medical Center, including contract hospitals, contract services, and other facilities. Analyze legal, regulatory, licensing and accreditation requirements and their impact on operations and oversee the development of compliance risk mitigation and corrective action plans. Ensure that controls are in place to guarantee privacy and security, to identify fraud, waste and abuse and to ensure that state and federal regulations are addressed. Collaborate with Medical Center leadership to ensure that operating procedures, systems and standards align with compliance requirements and controls and that staff is trained on these controls. Create and manage detailed audits of Health Plan and Hospital managed services. Develop strong collaborative leadership relationships with TPMG, external regulatory agencies and accreditation bodies, and use these relationships to manage risks and establish priorities and plans to address these risks. Ensure that the Medical Center has systems in place to achieve compliance by development of compliance management systems (such as training, policies, procedures, monitoring and auditing, among others) across all functions. Assist managers to adopt a culture of compliance in their daily operations. Oversee the development, implementation and evaluation of corrective action plans and responses to internally and externally identified compliance issues. Create and manage detailed on site audits of Health Plan and Hospital managed services. Co-lead the Medical Center Compliance Committee with TPMG partner and provide direction in establishing legislative and regulatory compliance strategy. Develop an audit plan and dashboard to communicate completion of corrective actions to senior leadership. Serve as the Privacy Officer and oversee systems to ensure the protection and security of member and patient health information. Ensure the integrity of the regional hotline process and conduct investigations to resolve compliance issues and complaints. In conjunction with Medical Center and Regional leaders, ensure that medical center service delivery changes meet requirements of state and federal regulators as well as billing requirements of Medicare and other federal coverage guidelines. Oversee medical center responses to external regulatory agencies such as CMS and the Federal Office of Civil Rights. Manage identified privacy breaches to ensure that all reports are filed, root cause analysis is performed and that controls are initiated to prevent further loss of protected health information. Provide oversight to the implementation of revenue cycle functions and ensure the remediation of Site of Service, Scope of Practice and billing/documentation issues. Responsible for identifying risk areas in the revenue cycle, including accurate coding and documentation. Work with Regional groups and HIM managers to implement compliance coding and documentation practices. Ensure that appropriately credentialed providers are supplying services to health plan and government sponsored groups. Lead education and implementation of new state and federal laws affecting care delivery and health plan operations.

The candidate should have a Bachelor's degree or equivalent in health care administration, business or public health administration, operations research, nursing, economics or other related field. Master's degree in Business, Health Care, Public Administration, J.D. or related field preferred. Must have 8-10 years of experience in hospital operations or multifaceted health care systems and multi-provider settings. Experience in revenue cycle, program development and strategic planning is required. Certified in Healthcare Compliance (CHC) or other equivalent compliance certification preferred. Should have knowledge of accreditation and licensing requirements including: The Joint Commission, NCQA, Knox Keene Act, CMS, Cal-OSHA, HIPAA, MEDI-Cal regulations and standards.
Legal 8 - 10 Full-time 2013-03-22

Kentucky - Medicaid Compliance Advisor

Louisville KY Medicaid Compliance Advisor
The candidate will analyze data, provide research services, and provide advice to minimize compliance risk exposure to the company. Will be part of a team who will develop and maintain key relationships both internally with company operational leaders as well as externally with the State Medicaid Officer, CMS and other regulators. Review and analyze market documents and data to identify what can be used to evidence meeting regulatory standards. Define regulatory and contract requirements to be interpreted, monitored and audited by appropriate Departments. Coordinate and manage a standard set of information relating to regulatory standards. Perform assessments, develop action plans, and provide guidance to operations groups. Build relationships with responsible market contacts and external regulators. Serve as a translator between business leaders and State Medicaid Departments, assisting with the interpretation of the intention of the guidelines. Manage day to day interaction with outside regulators. Coordinate on-site audits, working with the regulators during their visits. Post site audits and negotiate findings to mitigate potential fines and sanctions. Provide oversight and monitor corrective action plan development. Meet established expectations and takes responsibility for achieving results; encourage others to do the same. Consistently model and inspire high levels of integrity, lives up to commitments, and takes responsibility for the impact of one's actions. Effectively leverage resources to create exceptional outcomes, embraces change, and constructively resolves barriers and constraints. Understand oneself, effectively manages emotions, listens and communicates with respect, and builds trusting relationships.

The candidate should have a Bachelor's degree or equivalent relevant experience. A J.D. degree is desired. Must have 2-5 years of experience in Health Plan Compliance. Advanced experience working in a Compliance related field is needed. Should have experience working with regulatory agencies, including state departments of health insurance and CMS. Must be knowledgeable in process improvement and metrics development. Should be knowledgeable in regulations governing health care industries.
Legal 2 - 5 Full-time 2013-03-15

Minnesota - Vice President of Health Policy

Minnetonka MN Vice President of Health Policy
The candidate will serve as Health Reform, Affordable Care Act (ACA), and general health policy subject matter expert for company. Will understand key provisions of the law and regulations and communicate business impact and opportunities to Community and State health plan and functional leads on a regular basis. Create and lead a small team focused on health reform implementation for Community and State that assures compliance with ACA, and develop, evolve and execute a comprehensive work plan for health reform readiness in 2013 and 2014. Represent Community and State on broader Group reform readiness and policy development issues, notably health insurance exchange strategy and implementation with the Employer and Individual team, and ACA policy development with all Group business segments. Support health plans in advocacy to states on strategies to deploy ACA. Regularly engage, educate and monitor the progress of key business partners (e.g. benefit operations, network development, etc.) to support a successful implementation of the ACA Medicaid expansion in 2014. Create and update a policy analysis capability within Community and State as it relates to the ACA with particular focus on Medicaid expansion options under the ACA, the tax on insurers and the intersection between Medicaid and the Exchanges. Work closely with Group Government Affairs on policy development and execution. Represent Community and State with external health policy groups, legislators, and regulators to advocate for favorable market conditions and market expansion opportunities. Perform similar functions for Community and State related to other future health care policies and regulations. Report to the Chief of Staff for Community and State.

The candidate should have an undergraduate degree or equivalent experience. Law degree and prior policy or legislative experience strongly preferred. Must have 10+ years of experience working with or advising on Healthcare Government programs with 5+ years of experience in legal, legislative, or public policy domains. Knowledge of the political and rule making process needed. Experience working in politics or government is an asset. Travel may be required.
Legal 10 - 15 Full-time 2013-03-08

District of Columbia - Vice President of Health Policy

Washington DC Vice President of Health Policy
The candidate will serve as Health Reform, Affordable Care Act (ACA), and general health policy subject matter expert for company. Will understand key provisions of the law and regulations and communicate business impact and opportunities to Community and State health plan and functional leads on a regular basis. Create and lead a small team focused on health reform implementation for Community and State that assures compliance with ACA, and develop, evolve and execute a comprehensive work plan for health reform readiness in 2013 and 2014. Represent Community and State on broader Group reform readiness and policy development issues, notably health insurance exchange strategy and implementation with the Employer and Individual team, and ACA policy development with all Group business segments. Support health plans in advocacy to states on strategies to deploy ACA. Regularly engage, educate and monitor the progress of key business partners (e.g. benefit operations, network development, etc.) to support a successful implementation of the ACA Medicaid expansion in 2014. Create and update a policy analysis capability within Community and State as it relates to the ACA with particular focus on Medicaid expansion options under the ACA, the tax on insurers and the intersection between Medicaid and the Exchanges. Work closely with Group Government Affairs on policy development and execution. Represent Community and State with external health policy groups, legislators, and regulators to advocate for favorable market conditions and market expansion opportunities. Perform similar functions for Community and State related to other future health care policies and regulations. Report to the Chief of Staff for Community and State.

The candidate should have an undergraduate degree or equivalent experience. Law degree and prior policy or legislative experience strongly preferred. Must have 10+ years of experience working with or advising on Healthcare Government programs with 5+ years of experience in legal, legislative, or public policy domains. Knowledge of the political and rule making process needed. Experience working in politics or government is an asset. Travel may be required.
Legal 10 - 15 Full-time 2013-03-08

Illinois - Counsel

Lake County IL Counsel
The candidate will handle a variety of business transactions and provide legal, regulatory and compliance counsel to US proprietary pharmaceuticals division. Responsible for compliance with applicable corporate and divisional policies and procedures. Serve as Counsel for one or more pharmaceutical brands and frequently interact with and provide substantive advice to marketing, medical affairs and regulatory affairs departments concerning a broad range of legal, regulatory and compliance issues, including FDA regulations, False Claims Act, Anti-Kickback Statute, OIG guidance, the PhRMA Code, the Sunshine Act, Foreign Corrupt Practices Act and competition law in connection with product labeling, promotional and non-promotional activities, marketing strategies, sales compensation, government reimbursement, and interactions with healthcare professionals. Responsible for preparing, reviewing and negotiating complex commercial agreements, 3rd party vendor agreements, service agreements, consulting agreements and other corporate agreements. Provide legal advice and assistance for the development of policies and training, and conduct training. Resolve routine legal matters in practice area with direct supervision as needed from more experienced attorneys. Assist more experienced attorneys in resolving complex legal issues on cross-functional projects. Develop knowledge of Abbott's business and supported client areas. Keep abreast of changes in laws that affect client areas. Resolve legal issues using negotiation skills and legal expertise. Help select and direct the work of outside counsel, define project objectives and manage project.

The candidate should have a J.D. degree and appropriate licensure to practice law in Illinois as an in-house counsel. Must have 5-7 years of experience in health care law, and a record of demonstrated success in serving as a business partner and counseling clients on a wide range of health care issues at a major law firm or corporation without requiring substantial oversight and guidance from a managing attorney. Experience in FDA advertising/promotion regulations and health care laws compliance/fraud and abuse laws is required. Prior experience in the health care industry in an in-house position is preferred.
Legal 5 - 7 Full-time 2013-03-07

Texas - Senior Counsel, Regulatory

Dallas TX Senior Counsel, Regulatory
The candidate will report to an Assistant General Counsel. Will analyze potential compliance issues and provide regulatory guidance to hospitals, outpatient centers and physician practices. Practice independently and have direct interaction with hospital administration, home office leaders, other counsel as well as government agencies. Work with home office departments such as compliance, quality, audit and others on special projects.

The candidate should have a J.D. degree from an ABA accredited institution and license to practice law, preferably in Texas. Must have 5+ years of experience in healthcare law, preferably with law firm experience. Should be proficient in federal healthcare program requirements and hospital compliance program obligations. Regulatory experience in the following areas would be beneficial: Federal healthcare program Reimbursement, Stark, Antikickback, EMTALA, HIPAA, Conditions of Participation and Joint Commission requirements.
Legal 5 - 7 Full-time 2013-03-02

Rhode Island - Senior Legal Counsel - Healthcare

Woonsocket RI Senior Legal Counsel - Healthcare
The candidate will advise internal business partners on health care regulatory, marketing and contractual issues. Will provide legal advice and support to inquiries and requests. Review and analyze applicable statutes and regulations. Draft and/or review contracts, licenses and other materials. Review and monitor ongoing programs and operations, including marketing programs and initiatives. Serve as a subject matter expert to the Legal Department, Marketing Department, Government Relations, Compliance and other business units. Report to the Senior Legal Counsel.

The candidate should have a J.D. degree, preferably from a highly-regarded law school. Must have 7+ years of legal experience focused on health care regulatory law. Should have strong knowledge of health care law, with a preference for familiarity with issues relevant to health care providers. Law firm experience with some in-house and/or government experience preferred. Litigation and/or privacy law experience is desired.
Legal 7 - 9 Full-time 2013-02-27
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Health Privacy Counsel
In-House,Apple Inc.
Location : Santa Clara Valley, CA, United States

Health Privacy Counsel The candidate will have the opportunity to work with a dynamic team on privacy issues impacting company?s business and products globally. Work directly with business and engineering teams to design innovative privacy solutions... + read more

sep 20, 2018


Associate Attorney
In-House,Washington & West, LLC
Location : Towson, MD, United States

Associate Attorney The candidate provides great opportunity for career development and advancement, as well as vast personal/professional growth. Should have excellent written and oral communication skills. Healthcare or health law experience is a ... + read more

sep 19, 2018


 1 2 3 
 
Health Care Counsel
Refer job# NIND140613
 
Health Care Counsel The candidate provides proactive legal advice and counsel on issues related to the dynamic firm group and supports the products and services incorporated within the firm book of business including but not limited to supporting providers in providing value-based care through provider engagement services. Will support the Business in addressing legal, operational and escalated regulatory compliance issues requiring legal intervention related to firm products and services, with a focus on problem solving and solution based advice; will assist with the review, analysis and editing of contract documents such as non-disclosure agreements, business associate agreements, management services agreements, practice transformation agreements, and administrative services agreements; will provide legal support to firm business regarding new market and product development and company strategy, organizational business projects and fulfillment of operational and strategic goals. Accountable for a working knowledge and expertise of state and federal laws and regulations pertaining to management of provider entities such as IPA s, CIN s and physician practices, laws and regulations related to provider incentive and gain sharing arrangements, state and federal requirements related to delegated entities and downstream provider networks, legal and regulatory requirements related to the creation and maintenance of clinically integrated networks, fully-insured and governmental product offerings, the Affordable Care Act, and federal and state privacy laws and regulations including the HIPAA Privacy and Security Rule. Collaborates with business, operational risk and compliance staff to identify known and potential regulatory, legal and business risks impacting firm operations. Assist with the interpretation of federal and state laws to assess impact on firm operations and strategy. Should preferably have 6-8 years corporate legal department or relevant law firm experience. Must have JD degree from accredited law school and Bar membership. Strong analytical skills are required. Familiarity with managed care products and (fully insured and governmental) downstream provider networks and regulatory requirements governing such environments is desired. Strong drafting and contract writing skills, developed negotiating skills and the ability to work with a high degree of independence with demonstrated results is needed. Strong experience in measuring and analyzing process as well as results, to identify opportunities for improvement is must.
 
EMAIL TO COLLEAGUE  PERMALINK
 
Health Care Counsel
Refer job# RRAV140614
 
Health Care Counsel The candidate provides proactive legal advice and counsel on issues related to the dynamic firm group and supports the products and services incorporated within the firm book of business including but not limited to supporting providers in providing value-based care through provider engagement services. Will support the Business in addressing legal, operational and escalated regulatory compliance issues requiring legal intervention related to firm products and services, with a focus on problem solving and solution based advice; will assist with the review, analysis and editing of contract documents such as non-disclosure agreements, business associate agreements, management services agreements, practice transformation agreements, and administrative services agreements; will provide legal support to firm business regarding new market and product development and company strategy, organizational business projects and fulfillment of operational and strategic goals. Accountable for a working knowledge and expertise of state and federal laws and regulations pertaining to management of provider entities such as IPA s, CIN s and physician practices, laws and regulations related to provider incentive and gain sharing arrangements, state and federal requirements related to delegated entities and downstream provider networks, legal and regulatory requirements related to the creation and maintenance of clinically integrated networks, fully-insured and governmental product offerings, the Affordable Care Act, and federal and state privacy laws and regulations including the HIPAA Privacy and Security Rule. Collaborates with business, operational risk and compliance staff to identify known and potential regulatory, legal and business risks impacting firm operations. Assist with the interpretation of federal and state laws to assess impact on firm operations and strategy. Should preferably have 6-8 years corporate legal department or relevant law firm experience. Must have JD degree from accredited law school and Bar membership. Strong analytical skills are required. Familiarity with managed care products and (fully insured and governmental) downstream provider networks and regulatory requirements governing such environments is desired. Strong drafting and contract writing skills, developed negotiating skills and the ability to work with a high degree of independence with demonstrated results is needed. Strong experience in measuring and analyzing process as well as results, to identify opportunities for improvement is must.
 
EMAIL TO COLLEAGUE  PERMALINK
 
Health Care Counsel
Refer job# SULB140615
 
Health Care Counsel The candidate provides proactive legal advice and counsel on issues related to the dynamic firm group and supports the products and services incorporated within the firm book of business including but not limited to supporting providers in providing value-based care through provider engagement services. Will support the Business in addressing legal, operational and escalated regulatory compliance issues requiring legal intervention related to firm products and services, with a focus on problem solving and solution based advice; will assist with the review, analysis and editing of contract documents such as non-disclosure agreements, business associate agreements, management services agreements, practice transformation agreements, and administrative services agreements; will provide legal support to firm business regarding new market and product development and company strategy, organizational business projects and fulfillment of operational and strategic goals. Accountable for a working knowledge and expertise of state and federal laws and regulations pertaining to management of provider entities such as IPA s, CIN s and physician practices, laws and regulations related to provider incentive and gain sharing arrangements, state and federal requirements related to delegated entities and downstream provider networks, legal and regulatory requirements related to the creation and maintenance of clinically integrated networks, fully-insured and governmental product offerings, the Affordable Care Act, and federal and state privacy laws and regulations including the HIPAA Privacy and Security Rule. Collaborates with business, operational risk and compliance staff to identify known and potential regulatory, legal and business risks impacting firm operations. Assist with the interpretation of federal and state laws to assess impact on firm operations and strategy. Should preferably have 6-8 years corporate legal department or relevant law firm experience. Must have JD degree from accredited law school and Bar membership. Strong analytical skills are required. Familiarity with managed care products and (fully insured and governmental) downstream provider networks and regulatory requirements governing such environments is desired. Strong drafting and contract writing skills, developed negotiating skills and the ability to work with a high degree of independence with demonstrated results is needed. Strong experience in measuring and analyzing process as well as results, to identify opportunities for improvement is must.
 
EMAIL TO COLLEAGUE  PERMALINK
 
 
California - Hospital Health Plan Compliance Officer
Refer job# HZ1K25988
 
Hospital Health Plan Compliance Officer
The candidate will serve as the Hospital and Health Plan Compliance Officer, the Privacy Officer, and as a member of the Medical Center Leadership team. Will be responsible for the strategic development, implementation and evaluation of compliance management systems at the Medical Center, including contract hospitals, contract services, and other facilities. Analyze legal, regulatory, licensing and accreditation requirements and their impact on operations and oversee the development of compliance risk mitigation and corrective action plans. Ensure that controls are in place to guarantee privacy and security, to identify fraud, waste and abuse and to ensure that state and federal regulations are addressed. Collaborate with Medical Center leadership to ensure that operating procedures, systems and standards align with compliance requirements and controls and that staff is trained on these controls. Create and manage detailed audits of Health Plan and Hospital managed services. Develop strong collaborative leadership relationships with TPMG, external regulatory agencies and accreditation bodies, and use these relationships to manage risks and establish priorities and plans to address these risks. Ensure that the Medical Center has systems in place to achieve compliance by development of compliance management systems (such as training, policies, procedures, monitoring and auditing, among others) across all functions. Assist managers to adopt a culture of compliance in their daily operations. Oversee the development, implementation and evaluation of corrective action plans and responses to internally and externally identified compliance issues. Create and manage detailed on site audits of Health Plan and Hospital managed services. Co-lead the Medical Center Compliance Committee with TPMG partner and provide direction in establishing legislative and regulatory compliance strategy. Develop an audit plan and dashboard to communicate completion of corrective actions to senior leadership. Serve as the Privacy Officer and oversee systems to ensure the protection and security of member and patient health information. Ensure the integrity of the regional hotline process and conduct investigations to resolve compliance issues and complaints. In conjunction with Medical Center and Regional leaders, ensure that medical center service delivery changes meet requirements of state and federal regulators as well as billing requirements of Medicare and other federal coverage guidelines. Oversee medical center responses to external regulatory agencies such as CMS and the Federal Office of Civil Rights. Manage identified privacy breaches to ensure that all reports are filed, root cause analysis is performed and that controls are initiated to prevent further loss of protected health information. Provide oversight to the implementation of revenue cycle functions and ensure the remediation of Site of Service, Scope of Practice and billing/documentation issues. Responsible for identifying risk areas in the revenue cycle, including accurate coding and documentation. Work with Regional groups and HIM managers to implement compliance coding and documentation practices. Ensure that appropriately credentialed providers are supplying services to health plan and government sponsored groups. Lead education and implementation of new state and federal laws affecting care delivery and health plan operations.

The candidate should have a Bachelor's degree or equivalent in health care administration, business or public health administration, operations research, nursing, economics or other related field. Master's degree in Business, Health Care, Public Administration, J.D. or related field preferred. Must have 8-10 years of experience in hospital operations or multifaceted health care systems and multi-provider settings. Experience in revenue cycle, program development and strategic planning is required. Certified in Healthcare Compliance (CHC) or other equivalent compliance certification preferred. Should have knowledge of accreditation and licensing requirements including: The Joint Commission, NCQA, Knox Keene Act, CMS, Cal-OSHA, HIPAA, MEDI-Cal regulations and standards.
 
EMAIL TO COLLEAGUE  PERMALINK
 
Kentucky - Medicaid Compliance Advisor
Refer job# IPT025881
 
Medicaid Compliance Advisor
The candidate will analyze data, provide research services, and provide advice to minimize compliance risk exposure to the company. Will be part of a team who will develop and maintain key relationships both internally with company operational leaders as well as externally with the State Medicaid Officer, CMS and other regulators. Review and analyze market documents and data to identify what can be used to evidence meeting regulatory standards. Define regulatory and contract requirements to be interpreted, monitored and audited by appropriate Departments. Coordinate and manage a standard set of information relating to regulatory standards. Perform assessments, develop action plans, and provide guidance to operations groups. Build relationships with responsible market contacts and external regulators. Serve as a translator between business leaders and State Medicaid Departments, assisting with the interpretation of the intention of the guidelines. Manage day to day interaction with outside regulators. Coordinate on-site audits, working with the regulators during their visits. Post site audits and negotiate findings to mitigate potential fines and sanctions. Provide oversight and monitor corrective action plan development. Meet established expectations and takes responsibility for achieving results; encourage others to do the same. Consistently model and inspire high levels of integrity, lives up to commitments, and takes responsibility for the impact of one's actions. Effectively leverage resources to create exceptional outcomes, embraces change, and constructively resolves barriers and constraints. Understand oneself, effectively manages emotions, listens and communicates with respect, and builds trusting relationships.

The candidate should have a Bachelor's degree or equivalent relevant experience. A J.D. degree is desired. Must have 2-5 years of experience in Health Plan Compliance. Advanced experience working in a Compliance related field is needed. Should have experience working with regulatory agencies, including state departments of health insurance and CMS. Must be knowledgeable in process improvement and metrics development. Should be knowledgeable in regulations governing health care industries.
 
EMAIL TO COLLEAGUE  PERMALINK
 
Minnesota - Vice President of Health Policy
Refer job# 5Z2G25825
 
Vice President of Health Policy
The candidate will serve as Health Reform, Affordable Care Act (ACA), and general health policy subject matter expert for company. Will understand key provisions of the law and regulations and communicate business impact and opportunities to Community and State health plan and functional leads on a regular basis. Create and lead a small team focused on health reform implementation for Community and State that assures compliance with ACA, and develop, evolve and execute a comprehensive work plan for health reform readiness in 2013 and 2014. Represent Community and State on broader Group reform readiness and policy development issues, notably health insurance exchange strategy and implementation with the Employer and Individual team, and ACA policy development with all Group business segments. Support health plans in advocacy to states on strategies to deploy ACA. Regularly engage, educate and monitor the progress of key business partners (e.g. benefit operations, network development, etc.) to support a successful implementation of the ACA Medicaid expansion in 2014. Create and update a policy analysis capability within Community and State as it relates to the ACA with particular focus on Medicaid expansion options under the ACA, the tax on insurers and the intersection between Medicaid and the Exchanges. Work closely with Group Government Affairs on policy development and execution. Represent Community and State with external health policy groups, legislators, and regulators to advocate for favorable market conditions and market expansion opportunities. Perform similar functions for Community and State related to other future health care policies and regulations. Report to the Chief of Staff for Community and State.

The candidate should have an undergraduate degree or equivalent experience. Law degree and prior policy or legislative experience strongly preferred. Must have 10+ years of experience working with or advising on Healthcare Government programs with 5+ years of experience in legal, legislative, or public policy domains. Knowledge of the political and rule making process needed. Experience working in politics or government is an asset. Travel may be required.
 
EMAIL TO COLLEAGUE  PERMALINK
 
 
District of Columbia - Vice President of Health Policy
Refer job# 0HZW25826
 
Vice President of Health Policy
The candidate will serve as Health Reform, Affordable Care Act (ACA), and general health policy subject matter expert for company. Will understand key provisions of the law and regulations and communicate business impact and opportunities to Community and State health plan and functional leads on a regular basis. Create and lead a small team focused on health reform implementation for Community and State that assures compliance with ACA, and develop, evolve and execute a comprehensive work plan for health reform readiness in 2013 and 2014. Represent Community and State on broader Group reform readiness and policy development issues, notably health insurance exchange strategy and implementation with the Employer and Individual team, and ACA policy development with all Group business segments. Support health plans in advocacy to states on strategies to deploy ACA. Regularly engage, educate and monitor the progress of key business partners (e.g. benefit operations, network development, etc.) to support a successful implementation of the ACA Medicaid expansion in 2014. Create and update a policy analysis capability within Community and State as it relates to the ACA with particular focus on Medicaid expansion options under the ACA, the tax on insurers and the intersection between Medicaid and the Exchanges. Work closely with Group Government Affairs on policy development and execution. Represent Community and State with external health policy groups, legislators, and regulators to advocate for favorable market conditions and market expansion opportunities. Perform similar functions for Community and State related to other future health care policies and regulations. Report to the Chief of Staff for Community and State.

The candidate should have an undergraduate degree or equivalent experience. Law degree and prior policy or legislative experience strongly preferred. Must have 10+ years of experience working with or advising on Healthcare Government programs with 5+ years of experience in legal, legislative, or public policy domains. Knowledge of the political and rule making process needed. Experience working in politics or government is an asset. Travel may be required.
 
EMAIL TO COLLEAGUE  PERMALINK
 
Illinois - Counsel
Refer job# XL5U25809
 
Counsel
The candidate will handle a variety of business transactions and provide legal, regulatory and compliance counsel to US proprietary pharmaceuticals division. Responsible for compliance with applicable corporate and divisional policies and procedures. Serve as Counsel for one or more pharmaceutical brands and frequently interact with and provide substantive advice to marketing, medical affairs and regulatory affairs departments concerning a broad range of legal, regulatory and compliance issues, including FDA regulations, False Claims Act, Anti-Kickback Statute, OIG guidance, the PhRMA Code, the Sunshine Act, Foreign Corrupt Practices Act and competition law in connection with product labeling, promotional and non-promotional activities, marketing strategies, sales compensation, government reimbursement, and interactions with healthcare professionals. Responsible for preparing, reviewing and negotiating complex commercial agreements, 3rd party vendor agreements, service agreements, consulting agreements and other corporate agreements. Provide legal advice and assistance for the development of policies and training, and conduct training. Resolve routine legal matters in practice area with direct supervision as needed from more experienced attorneys. Assist more experienced attorneys in resolving complex legal issues on cross-functional projects. Develop knowledge of Abbott's business and supported client areas. Keep abreast of changes in laws that affect client areas. Resolve legal issues using negotiation skills and legal expertise. Help select and direct the work of outside counsel, define project objectives and manage project.

The candidate should have a J.D. degree and appropriate licensure to practice law in Illinois as an in-house counsel. Must have 5-7 years of experience in health care law, and a record of demonstrated success in serving as a business partner and counseling clients on a wide range of health care issues at a major law firm or corporation without requiring substantial oversight and guidance from a managing attorney. Experience in FDA advertising/promotion regulations and health care laws compliance/fraud and abuse laws is required. Prior experience in the health care industry in an in-house position is preferred.
 
EMAIL TO COLLEAGUE  PERMALINK
 
Texas - Senior Counsel, Regulatory
Refer job# N7ML25765
 
Senior Counsel, Regulatory
The candidate will report to an Assistant General Counsel. Will analyze potential compliance issues and provide regulatory guidance to hospitals, outpatient centers and physician practices. Practice independently and have direct interaction with hospital administration, home office leaders, other counsel as well as government agencies. Work with home office departments such as compliance, quality, audit and others on special projects.

The candidate should have a J.D. degree from an ABA accredited institution and license to practice law, preferably in Texas. Must have 5+ years of experience in healthcare law, preferably with law firm experience. Should be proficient in federal healthcare program requirements and hospital compliance program obligations. Regulatory experience in the following areas would be beneficial: Federal healthcare program Reimbursement, Stark, Antikickback, EMTALA, HIPAA, Conditions of Participation and Joint Commission requirements.
 
EMAIL TO COLLEAGUE  PERMALINK
 
 
Rhode Island - Senior Legal Counsel - Healthcare
Refer job# AVDE25708
 
Senior Legal Counsel - Healthcare
The candidate will advise internal business partners on health care regulatory, marketing and contractual issues. Will provide legal advice and support to inquiries and requests. Review and analyze applicable statutes and regulations. Draft and/or review contracts, licenses and other materials. Review and monitor ongoing programs and operations, including marketing programs and initiatives. Serve as a subject matter expert to the Legal Department, Marketing Department, Government Relations, Compliance and other business units. Report to the Senior Legal Counsel.

The candidate should have a J.D. degree, preferably from a highly-regarded law school. Must have 7+ years of legal experience focused on health care regulatory law. Should have strong knowledge of health care law, with a preference for familiarity with issues relevant to health care providers. Law firm experience with some in-house and/or government experience preferred. Litigation and/or privacy law experience is desired.
 
EMAIL TO COLLEAGUE  PERMALINK
 

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