Sr. Counsel/VP Health Plan Operations
Community Health Choice, Inc. (Community) is a non-profit managed care organization (MCO), licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 94 hospitals, Community serves over 400,000 Members with the following programs:
• Medicaid State of Texas Access Reform (STAR) program for low-income children and pregnant women
• Children’s Health Insurance Program (CHIP) for the children of low-income parents, which includes CHIP Perinatal benefits for unborn children of pregnant women who do not qualify for Medicaid STAR
• Health Insurance Marketplace Plans that offer individual health coverage that includes preventive care, emergency services, prescription drugs, and hospitalization available to all, regardless of pre-existing conditions.
• Community Health Choice (HMO D-SNP), a Medicare Advantage Dual Special Needs plan for people with both Medicare and Medicaid that combines Medicare Part A and Part B benefits, Medicare Part D prescription drug coverage, and Medicaid benefits with additional health benefits like dental, vision, transportation, and more.
Improving Members' experiences is at the heart of every Community position. We strive every day to make sure that our Members have access to the high-quality health care they need and deserve.
Community is accredited by URAC for its health plan operations. We offer care management programs for asthma, diabetes, and high-risk pregnancy. An affiliate of the Harris Health System (Harris Health), Community is financially self-sufficient and receives no financial support from Harris Health or from Harris County taxpayers.
Skills / Requirements
This newly created Legal Leadership position reports to and works closely with the Chief Legal Counsel and manages day-to-day legal issues for the Community Health Choice plan, including compliance, contracting, litigation, HR, privacy, and other operation issues. The Senior Counsel will also support the Chief Legal Counsel and plan leadership on special projects and will be responsible for managing and developing the Legal team and Legal department administration, such as budgeting and finance, outside counsel management, systems and other operational matters.
- Management of day-to-day legal issues, including contracting, HR, privacy, litigation/disputes, compliance and regulatory matters, including management of work delegated to other Legal team members and/or outside counsel.
- Develop and manage Community Health attorneys and paralegals, including formation of development plans, management of HR processes and building a positive team culture.
- Build and manage Legal Operations infrastructure that is innovate, cost effective and scalable as the organization and team grow. Assist Chief Legal Counsel in budgeting and other administration of the department, selection and management of outside counsel and other vendors and selection and implementation of software and system as need.
- Assist the Chief Legal Counsel as needed with Board and other governance issues, as well as special projects.
- Ensures effective collaboration with stakeholders in the process including Community Leadership and Business Owners, Harris County Purchasing Department, Harris County Attorney¿s office, and Outside Counsel.
- Maintains current knowledge, monitors changes, and provides research on Community¿s legal requirements including but not limited to, licenses, certifications and accreditations as well as the requirements of the Texas Administrative Code, Texas Insurance Code, Health and Human Services Commission (HHSC), Texas Department of Insurance (TDI), Health and Human Services (HHS), and other regulatory entities.
- Demonstrates Harris Health and Community Health Choice values, including trust, integrity, mutual respect, diversity, responsiveness and caring service.
- Actively contributes to achievement of departmental goals, as identified in Department¿s annual business plan, including specific departmental process improvement plans.
- Doctorate of Jurisprudence/JD degree and license to practice law in State of Texas.
- LLM Health Law a plus.
- Eight years' experience in-house in a Legal Department leadership role with broad subject matter expertise.
- Experience in a fast-pace, growth-oriented healthcare organization.
- Experience in a senior health care plan counsel role covering a range of legal matters preferred.
- Experience in manage care or provider affiliate health system plans a plus.
- Four years' experience in a management role
- Microsoft Office (Word, Excel, Outlook)
- Experience with Legal operating systems including e-billing, matter management and CLM tools.
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Job Status: Full Time
Job Reference #: 165800