System Director, Managed Care Counsel
Overview:
My client is seeking a seasoned legal professional to serve as System Director, Associate Counsel for Managed Care. This strategic role is responsible for providing legal guidance and support across a broad spectrum of managed care activities, including contract negotiation, regulatory compliance, and dispute resolution. The position plays a critical role in shaping payer relationships and ensuring that contractual arrangements align with organizational goals and legal standards.
Key Responsibilities:
- Lead and manage legal review and negotiation of managed care contracts with commercial payers, Medicare Advantage plans, Medicaid managed care organizations, and other third-party payers.
- Advise internal stakeholders-including Managed Care, Revenue Cycle, Business Development, and Legal departments-on contract terms, risk mitigation, and regulatory implications.
- Provide legal counsel on complex issues such as value-based arrangements, alternative payment models, and network participation.
- Monitor and interpret federal and state regulations affecting managed care, including ACA, HIPAA, Medicare/Medicaid rules, and antitrust laws.
- Support dispute resolution efforts, including payer audits, payment denials, and contract enforcement.
- Collaborate with compliance teams to ensure adherence to Stark Law, Anti-Kickback Statute, and other healthcare regulations.
- Develop and deliver training and education to internal teams on managed care legal matters.
Required Qualifications:
- Juris Doctor (JD) from an accredited law school.
- Active license to practice law in at least one U.S. jurisdiction.
- Minimum of 5 years of legal experience in healthcare law, with a strong focus on managed care.
- Demonstrated expertise in negotiating and drafting complex healthcare contracts.
- Deep understanding of healthcare reimbursement models, regulatory frameworks, and payer-provider dynamics.
- Excellent communication, analytical, and interpersonal skills.
Preferred Qualifications:
- Experience working in a health system, payer organization, or law firm serving healthcare clients.
- Familiarity with integrated delivery networks and value-based care initiatives.
FAQs
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