Description

VNS Health, comprising of one of the nation’s largest non-profit home and community-based health care organizations and growing health plans, is seeking a seasoned healthcare attorney to fill the role of Vice President and Associate General Counsel for Health Plans.  Reporting directly to the Executive Vice President and Chief Legal and Risk Officer, the successful candidate will act as the lead lawyer for VNS Health’s growing Medicare Advantage, Medicaid managed care and related government sponsored plans.  This role will provide hands-on counsel to VNS executive leadership and management on a wide range of legal issues affecting health plan operations including but not limited to member enrollment and eligibility, benefits administration, utilization management, appeals and grievances, care coordination and quality programs, provider contracting and network adequacy and credentialing.  The successful candidate will act as a trusted advisor to business partners balancing regulatory compliance with business objectives in a highly regulated, fast-moving healthcare environment.  The candidate will apprise management on the legal impact of legislative and regulatory developments affecting the policies and operations of VNS Health. In addition, in the role you will support audits, regulatory inquiries, corrective action plans, and interactions with CMS, state agencies and delegated entities.  The successful candidate will have strong legal acumen as evidenced by 8 years of relevant healthcare experience in advising Medicare Advantage and/or Medicaid managed care through a combination of law firm and/or in-house experience.  The successful candidate will have direct access to and engagement with senior leadership across the organization such that strong communication skills, business acumen and leadership skills are imperative.  

Requirements

•  Provides day to day legal counsel to the VNS health plans with regard to member enrollment and eligibility, benefits administration, utilization management, appeals and grievances, care coordination and quality programs, provider contracting and network adequacy and credentialing and other health plan related matters.
• Keeps abreast and apprises management of the legal impact of legislative and regulatory developments affecting the policies and operations of VNS Health, including those impacting health plan operations.
• Advises on legal issues and associated implications relating to specialized or new programs, lines of business, including health plan programs and benefits.
• Assists and advises with respect to corporate transactions and related legal and regulatory issues.
• Oversee organizations general contracting including managing paralegal and other legal professionals in day to day contract management workflows as well as acting as lead counsel for organizations large scale contracting initiatives.
• Serves as a legal advisor for VNS Health’s health plan lines of business, aligning legal guidance with business and operational priorities.
• Monitors and advises on legislative and regulatory developments impacting health plan operations and ensures timely communication of associated legal risks and implications to senior leadership.
• Collaborates with Risk and Compliance functions to identify, assess, and mitigate legal and operational risks specific to health plan operations.
• Applies strong business acumen in advising on legal issues affecting health plan operations.