Location Address:
Compensation Pay Range:
Summary:
Responsibilities:
Legal Role Responsibilities:
• Provide legal advice to business stakeholders to identify and mitigate legal, regulatory, and business risk in proposed business transactions
• Draft, review, revise and negotiate vendor and other commercial contracts and agreements
• Work with the appropriate business clients and other attorneys to resolve claims, contract disputes and threatened claims from vendors, providers and health plan members, including providing legal advice
• Provide legal support to the PHP Appeals & Grievances department on member and provider disputes, including managing Medicaid Fair Hearings, Medicare administrative law judge, and Commercial OSI hearing processes
• Provide support for contracting matters and provider-related disputes.
• Provide support to litigation team in defending health plan-related disputes, lawsuits and subpoenas
• Conduct legal research and monitor and stay current with changes in legislation at the state and federal level affecting health care operations.
• Provide education, training, and guidance in formal and informal settings on a regular basis to identify and mitigate legal risk across PHP and assist PHP business and operations teams with maintaining compliance with healthcare laws and regulations
• Provide backup coverage for other department attorneys and participate in the call rotation for after-hours legal emergencies
Turquoise Care Court Liaison Role Responsibilities:
• Single point of contact for court system stakeholders (e.g., state, federal, county, municipal, and tribal courts)
• Work with the member care coordination team to ensure members receive care coordination related to any court orders and case dispositions
• Coordinate all civil commitments and communication of court-related follow-up and requirements to appropriate staff
• Work with the member care coordination team to help ensure providers are adhering to the treatment requirements assigned through court-ordered treatment
Other Responsibilities:
• Work as a legal generalist with interest and willingness to take on and manage additional areas of responsibility over time
• Develop strong relationships with business partners and stakeholder
• Function as an effective team member with the ability to work in a matrix environment
Qualifications:
• Juris Doctor degree from an accredited law school and active license to practice law in one or more states and a member in good standing of the applicable state bar;
• New Mexico license to Practice Law preferred and must be acquired as soon as practicable following employment.
• At least 5 years experience practicing in general civil litigation, health law litigation, or attorney oversight of litigation from a risk management perspective
• Experience working in a litigation setting preferred.
• Strong communication and interpersonal skills with the ability to effectively interact with court personnel, healthcare providers and other stakeholders.
• Occasional in-state travel to various PHS facilities.
All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits.
Wellness Presbyterians Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being. Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges, webinar, preventive screening and more.
Why work at Presbyterian? As an organization, we are committed to improving the health of our communities. From hosting growers markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans.
About Presbyterian Healthcare Services Presbyterian exists to improve the health of patients, members, and the communities we serve. We are locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the states largest private employer with nearly 14,000 employees - including more than 1600 providers and nearly 4,700 nurses.
Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.
AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.
Were Determined to Support New Mexicos Well-Being | Presbyterian Healthcare Services