Operations Counsel

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Operations Counsel
The candidate will be responsible for: 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. Member in good standing of a U.S. State Bar (preferably one of Prospect’s states of operation). Should have 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. Strong leadership and management experience. Prior law firm and in-house experience is required. Experience in supporting integrated health care operational matters, including but not limited to Plan, IPA and Clinic governance, provider networks, reimbursement, payor and physician arrangements, marketing, surveys, licensure, and regulatory compliance are required. Must be Member in good standing of a U.S. State Bar (preferably one of Prospect’s states of operation).

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