|Under the supervision of the Deputy General Counsel, the Assistant General Counsel assists in providing in-house legal services to BMCHP. Legal services include the provision of legal advice and counseling to BMCHP management and staff on a broad variety of BMCHP business matters to ensure that BMCHP is operated and managed in accordance with all applicable laws and regulations.
- Provider Relationships: provide legal counsel with respect to provider contracting, provider disputes, and provider communications and policies.
- Pharmacy Service: provide legal counsel related to pharmacy benefits administration, contracting and oversight of pharmacy benefits manager (PBM) and specialty pharmacy providers.
- Vendor and IT Contracts: draft, review, revise and interpret vendor and IT contracts, and provide legal counsel as needed.
- Litigation: assist with litigation, including subpoenas, 93A demand responses, subrogation, provider audits, and class action recoveries, as needed.
- Confidentiality/Privacy: provide legal counsel with respect to federal and state confidentiality and privacy rules, including HIPAA.
- Marketing and Member Communications: provide legal counsel related to marketing and communications with members, including evidences of coverage and marketing materials.
- New Business Development: provide compliance advice with respect to new products and servicesRegulatory Compliance: interpret federal and state laws and regulations impacting BMCHP’s business, including but not limited to managed care laws, federal health reform, MassHealth, Connector Authority/QHP, New Hampshire Department of Health & Human Services, and Division of Insurance regulations, and provide related legal counsel to internal customers.
- Relationships: establish and maintain effective working relationships with internal customers, including members of the Executive Staff and Leadership Team, outside counsel, governmental representatives and regulators, and other third parties.
- Outside Counsel: establish and maintain effective working relationships with outside counsel and manage time and expenses associated with them.
- General supervision is received on a weekly basis.
- Juris Doctor of Laws from a duly accredited law school required.
- Current Massachusetts Bar membership required.
- Minimum five (5) years of legal experience required.
- Ability to draft contracts and other legal documents, negotiate contracts and determine appropriateness of potential legal actions.
- Demonstrated research and writing skills.
- Ability to analyze legal problems and provide efficient and effective legal services and advice.
- Ability to identify, strategize, anticipate and respond to a broad range of issues related to business, operations and risk management.
- At least three (3) years legal experience in a health care, Medicaid, and/or managed care environment strongly preferred.
- Additional experience in litigation
- Familiarity with federal and state laws and regulations applicable to the managed care industry.
- Additional New England states bar memberships, including New Hampshire.
|Certification or Conditions of Employment:
- Pre-employment background check
|Competencies, Skills, and Attributes:
- Strong oral and written communications skills essential.
- Strong interpersonal skills and ability to communication effectively throughout all levels of the organization as well as with external parties essential.
- Strong collaborative skills essential to maintain an effective working relationship with corporate-wide contacts
- Excellent judgment – ability to assess risks and benefits.
- Ability to work with limited supervision or independently
- Attendance: regular and reliable attendance is an essential function of the position.
|Working Conditions and Physical Efforts:
- Work is normally performed in a typical interior/office work environment.
- No or very limited physical effort required. No or very limited exposure to physical risk.
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