Vice President Associate General Counsel, Health Plan Services

Acts 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.  The successful candidate will act as a trusted advisor to the health plan business partners balancing regulatory compliance with business objectives in a highly regulated, fast-moving healthcare environment. 

What We Provide

• Referral bonus opportunities     
• Generous paid time off (PTO), starting at 30 days of paid time off and 9 company holidays   
• Health insurance plan for you and your loved ones, Medical, Dental, Vision, Life and Disability    
• Employer-matched retirement saving funds   
• Personal and financial wellness programs    
• Pre-tax flexible spending accounts (FSAs) for healthcare and dependent care     
• Generous tuition reimbursement for qualifying degrees   
• Opportunities for professional growth and career advancement    
• Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities 

What You Will Do

• Provides day to day legal counsel to the health plan 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.
  Acts as lead counsel for any health plan merger and acquisition initiatives including management of outside counsel.
• 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.
  
• Provides counsel to executive leadership and senior management on legal, regulatory, privacy, and risk considerations impacting health plan operations.
  
• Advises on health plan-related matters, including member enrollment, care coordination, service delivery, and termination.
  
• Provides legal support on healthcare regulatory matters affecting health plan operations. Partners with business and operational leadership to support health plan programs and initiatives.
  
• Oversees outside counsel and internal stakeholders in connection with Medicaid and Medicare fair hearings and disputes related to care coordination, service delivery, and termination of services. 
  
• 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.

Licenses and Certifications:
Current registration to practice law in New York State required

Education:
Juris Doctorate required

Work Experience:
Minimum of eight years of experience advising on or supporting health plan operations, health plan transactions and contracting matters, and healthcare regulatory matters.