Legal Counsel, Contracts

Job DescriptionJob Description

The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.

Remote position; must reside in California.

What You Will Be Doing:

Under general supervision, the Legal Counsel, Contracts is responsible for negotiating, drafting, and reviewing contracts supporting vendor and health care transactions. The Legal Counsel provides advice and counseling to internal stakeholders on a variety of complex and sensitive matters involving health plan operations and vendor/provider relationships, with the goals of ensuring legal and regulatory compliance and limiting risk exposure for HPSJ. Work is varied and complex and requires a high degree of discretion and independent judgment and is done with the highest level of ethics and integrity.

Our Vision:

Continuously improve the health of our community.

Our Mission:

We provide healthcare value and advance wellness through community partnerships.

Essential Functions

• Under supervision, responsible for legal reviews of vendor/administrative services contracts entered by HPSJ.
• In coordination with internal and external subject matter experts, negotiates, drafts and reviews contracts, delegation agreements, non-disclosure agreements, and other legal documents.
• Reviews and negotiates Business Associate Agreements to ensure HPSJ’s and Business Associates’ compliance with Health Insurance Portability and Accountability Act (HIPAA) privacy and security rules and state requirements regarding confidentiality of medical information.
• Analyzes and evaluates the risk level of key contract provisions.
• Conducts legal research and provides analysis on state and federal laws pertaining to health plans, managed care, provider contracting, Medi-Cal requirements, and Medicare requirements.
• Reviews policies and procedures related to subcontractor and provider relationships for compliance with regulatory requirements.
• Develops and maintains relationships with internal and external parties, including state regulators, based on trust and respect.
• Communicates directly with business owners to understand their business objectives and provide practical legal advice tailored to their needs.
• Acts as a non-supervisory advisor to business owners and Procurement and Contracting departments on various matters, including but not limited to privacy, vendor/administrative services contracts, and/or provider (hospitals, primary care physicians, specialist, ancillary providers, telehealth providers, etc.) contracts.
• Provides advice and assistance to the Compliance department in drafting and responding to filings or inquiries from regulators (e.g., Centers for Medicare and Medicaid Services, California Department of Managed Health Care, and California Department of Health Care Services).
• Provides day-to-day legal advice and analysis to internal stakeholders to define and develop solutions to regulatory requirements that impact various product lines and programs.
• Analyzes new legislation and regulatory requirements and effectively communicates the impact of such legislation and regulatory requirements to business owners.
• Proactively maintains up-to-date knowledge of developments in relevant federal and state legislation, regulations, and case law relevant to Medi-Cal managed care, Medicare, vendor contracting, provider contracting, and labor/employment laws.
• Takes ownership of projects, manages workflows efficiently, and ensures timely delivery of high-quality work.
• Establishes scalable contracting processes and contract templates.
• Makes timely adjustments to contracting process and revises contract templates in response to new legislation, regulatory requirements, and case law.
• Evaluates and analyzes legal claims brought against the organization.
• Manages and responds to disputes and litigation actions and works with external counsel, as needed.
• Develops policies and procedures for proper legal claims handling and training of staff.

Non-Essential Functions

• Other duties as assigned.

Education and Experience

Required

• Juris Doctor degree from an accredited law school.
• Outstanding academic credentials demonstrating a commitment to excellence.
• 4+ years practice in business law, commercial contracts, and/or business litigation.
• Strong written and oral communication skills
• Experience and proven results in negotiating and drafting commercial contracts.
• Experience in advising clients on contractual provisions, preferably in an in-house setting.
• Experience working in an environment highly regulated by government agencies.
• Experience with data protection, confidentiality, and privacy laws.

Strongly Preferred

• Experience in representing public agencies and strong knowledge of laws and regulations impacting public agencies, e.g., the Brown Act, Public Records Act, Government Claims Act.
• Experience with laws and regulations applicable to health care services plans, e.g., Welfare and Institutions Code, Knox-Keene Act, Titles 22 and 28 of the California Code of Regulation
• Experience with Medi-Cal managed care program requirements, especially requirements applicable to healthcare providers, delegation and subcontracting.
• Experience with Medicare Advantage program requirements, especially requirements applicable to healthcare providers and First Tier, Downstream, and Related Entities.
• Experience with general HMO/managed care plan business operations and requirements.
• Experience with peer review proceedings.
• Experience in employment and labor issues.

Licenses, Certifications

• Active, current, and unrestricted license to practice law in California the State Bar of California required
• Certification in Healthcare Compliance preferred

Knowledge, Skills, Abilities and Competencies

• Excellent oral and written communication skills, including ability to convey complex legal concepts clearly and persuasively in a manner tailor to internal or external stakeholders
• Strong analytical and problem-solving skills with attention to detail
• Ability to work independently or as part of a collaborative and supportive team environment
• Proven general counseling experience in a business environment.
• Strong knowledge and understanding of applicable California and Federal laws and regulations which govern HPSJ including California and Federal health laws, CCR & CFR, relevant case law, labor law, provider contracting, etc.)
• In-depth understanding of how legal issues affect Medi-Cal Managed Care and Medicare programs.
• Ability to anticipate and respond to legal issues or risks.
• Ability to provide expert advice or perform effective legal research on required terms and conditions for vendor contracting, provider contracting, employment related legal issues, and general healthcare compliance matters.
• Ability to develop legal strategy and objectives.
• Strong understanding of health plan operations.
• Ability to interpret and apply understanding of key financial indicators to make better business decisions.
• Effectively builds formal and informal relationship networks inside and outside of the organization.
• Ability to convey a compelling picture of the vision and strategy that motivates others to action.
• Makes sense of complex, high quantity, and sometimes contradictory information to effectively solve problems.
• Plans and prioritizes work to meet commitments aligned with organizational goals.
• Secures and deploys resources effectively and efficiently.
• Creates a climate where people are motivated to do their best to help the organization achieve its objectives.
• Steps up to address difficult issues; says what needs to be said.
• Handles conflict situations effectively, with a minimum amount of noise.
• Holds self and others accountable to meet commitments.
• Adapts approach and demeanor in real time to match the shifting demands of different situations.
• Develops and delivers multi-mode communications that convey a clear understanding of the unique needs of different audiences.
• Recognizes the value that different perspectives and cultures bring to an organization.
• Demonstrates a high degree of professional ethics, integrity and gravitas and gains the confidence and trust of others through honesty, integrity and authenticity.
• Strong presentation skills, including the ability to tailor presentations to a specific audience, and address and interact with large groups.
• Demonstrated ability to articulate and support HPSJ’s vision, mission, values and strategy, integrate into management practices, and foster their manifestation among staff.
• Expert level of competency in the use of MS Word and intermediate level with all other Microsoft software including Outlook, PowerPoint, SharePoint and Excel.
• Ability to speak and be understood in English.
• Ability to handle confidential information with appropriate discretion.

Physical Demands

Frequent sitting, standing and walking, constant repetitive motion, constant talking and listening, occasional handling of materials up to 10 lbs., close up and distance vision requirements, occasional travel.

Emotional/Psychological Demands

Ability to cope with a fast-paced work environment, working under pressure, dynamic priorities and deadlines, constant decision making, working irregular hours, occasional public contact.

Work Environment

Open office environment; moderate temperatures; moderate noise levels.

Eligible for remote work.

We are an equal opportunity employer and diversity is one of our core values. We believe that differences including race, ethnicity, gender, sexual orientation, and other characteristics, will help us create a strong organization that is sensitive to the needs of those we serve. Employment decisions are made on the basis of qualifications and merit.

HPSJ provides equal employment opportunities to employees and applicants for employment and prohibits discrimination based on color, race, gender (including gender identity and gender expression), religion (including religious dress and grooming practices), marital status, registered domestic partner status, age, national origin (including language use) or ancestry, physical or mental disability, medical condition (including cancer and genetic characteristics), sex (including pregnancy, childbirth, breastfeeding or related medical condition), genetic information, sexual orientation, military or veteran status, political affiliation or any other characteristic made unlawful by applicable Federal, State or local laws. It also prohibits unlawful discrimination based on the perception that anyone has these characteristics or is associated with anyone who has or is perceived to have these characteristics.

Important Notice: This job description is not a contract between HPSJ and the employee performing the job. The duties listed in the job description may be changed at the discretion of HPSJ, and HPSJ may request the employee to perform duties that are not listed on the job description.

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