- Reporting to the General Counsel, the Associate General Counsel will lead the legal team responsible for transactional and regulatory matters related to provider networks including payment contracts, new product development for employer accounts, and state and federal health care reform. This individual will manage a team of attorneys in supporting business implementation of complex hospital and physician payment arrangements including the Alternative Quality Contract (AQC), a key initiative for the company; serve as a trusted advisor for senior leaders across the company on strategic initiatives and the development of innovative solutions to achieve business goals while maintaining regulatory compliance and mitigating risk; and stay abreast of health care reform developments that may impact provider networks and future company initiatives.
- This individual will also have the opportunity to guide and counsel the business on contract disputes, and support other areas/projects of interest within the law department.
- Collaborate regularly with senior business leaders on provider network contracting strategy relative to business goals and applicable law including state and federal health care reform. Represent company and protect the company's rights in negotiations, settlements and litigation with providers and other external parties.
- Manage legal team support of contract development and execution for contracts within AQC, hospital, and other complex pay-for-performance contracts in agreed upon timeframes.
- Define, lead, and support the development of associates across the Legal team. Includes direct leadership responsibilities and knowledge sharing mentor relationships
- Reduce business/financial risk by helping the business negotiate and execute accurate and enforceable contracts.
- Consult with product team on new benefit designs that may involve unique provider networks including limited and tiered networks.
- Communicate effectively with senior executives in diverse business areas that interface with provider matters, including finance/actuarial, provider measurement, product, communication, audit, and sales, and manage legal team support of these business functions with focus on business needs and regulatory compliance.
- Relay complex legal principles to business leaders at all levels to determine relevance to the business and to place legal risk into the proper business context.
- Formulate innovative solutions to mitigate legal risk in a manner that supports business objectives and priorities.
- Represent law department as part of multi-functional teams with authority and responsibility to evaluate and gauge legal risk and advise clients accordingly.
- Perform other legal duties based on new opportunities that arise within the law department.
Experience and Education:
- BA/BS and JD degrees required
- Massachusetts License to practice law
- At least ten years of experience required, preferably in health care or financial services industries.
- Strong drafting and negotiating skills and the ability to review, revise and draft contracts in an efficient and accurate manner.
- Knowledge of health care regulatory compliance and contracting matters on payor or provider side, strongly preferred.
- Experience managing attorneys in a high-volume practice, strongly preferred.
- Excellent business acumen and judgment, including ability to place legal risk in proper business context.
- Ability to take in large amounts of complex information quickly in order to provide the business with on-the-spot risk evaluation and recommendations for key decisions.
- Ability to work with complex financial arrangements and skillful in translating financial terms into contract language.
- Ability to formulate innovative solutions to mitigate legal risk in a manner that supports business objectives and priorities.
- Strong client management skills including influencing skills and organizational astuteness and demonstrated ability to cultivate and maintain positive working relationships with key customers.
- Demonstrated presentation skills.
- Ability to deal effectively with ambiguous situations.
- Excellent written and verbal communication skills.
- Strong organizational and prioritization skills.
- Ability to work independently and effectively represent law department as part of multi-functional teams.
- High degree of professionalism along with ability to effectively interact with all levels of organization.
- Flexibility and interest in taking on additional work/projects as opportunities arise.
Blue Cross Blue Shield of Massachusetts - 10 months ago