Operations Counsel Managed Care Ipas And Clinic Operations

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Operations Counsel, Managed Care, Ipas And Clinic Operations
The candidate will be responsible for certain day-to-day oversight of, and participation in, Prospect’s portfolio of (a) managed care contracting, including Prospect’s Coordinated Regional Care operations, health care service plan, and risk bearing organizations, (b) Independent Physician Associations (aka Medical Groups) and (c) stand-alone clinics. Operations Counsel assigned to one or more Managed Care entity, plan, IPA or clinic will report directly to the Deputy General Counsel, Managed Care, IPAs and Clinic Operations, who reports directly to the General Counsel. Primary Responsibilities : Responsible for supporting certain day-to-day operations for assigned Managed Care, IPAs and Clinic operations in Prospect’s portfolio; Drafting and developing organizational policies and procedures. Counseling management daily on a range of legal and regulatory issues, including licensure, credentialing and performance incentives. Working with the Contracting department and operators to structure, develop and draft payor arrangements that maximize reimbursement for services provided or arranged for Health Plan members. Working with the Contracting department and operators to structure, develop and draft a variety of physician arrangements, to properly align interests and ensure compliance with fraud and abuse laws and physician self-referral laws. Working closely with members of Senior Management, including Compliance department. Assisting with internal investigations, including management of outside counsel. Managing payor disputes pertaining to reimbursement, including management of outside counsel and collection vendors. Effectively responding to outside regulatory agencies. Creating and disseminating legal education modules to field personnel related to the requirements of the existing regulatory environment.Developing programs and tools to assist with efficient, compliant day-to-day operations, including the recommendation and implementation of systems. Designing, implementing and monitoring compliant operational structures to meet organizational goals. Must have J.D. from a nationally recognized law school. Should be a member in good standing of a U.S. State Bar (preferably one of Prospect’s states of operation). Must have minimum of 5 years of relevant legal experience, including work in a for-profit healthcare setting and experience with an integrated healthcare delivery system and/or risk-bearing organization.

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