General Counsel and Sr Leader, Gov't Affairs & Compliance

Schenectady, NY - Posted: 12/20/17 | SHARE:

Description:



MVP Health Care is a nationally-recognized, regional not-for- profit health plan. We are committed to having a positive impact on the health and wellness of everyone and every community we serve. We care for more than 700,000 members across New York and Vermont, and we are powered by the ideas and energy of more than 1,600 employees – providing a wide range of health benefit plan options with attentive service and flexibility normally associated with a smaller company. Stop settling for “just a job,” and join a company where you can reach your full potential…and make a positive difference!

JOB TITLE: General Counsel and Sr Leader, Gov't Affairs & Compliance (Job ID: 1126)
STATUS: Full-time, Exempt
LOCATION: Schenectady

JOB SUMMARY:
The General Counsel &; Senior Leader, Government Affairs & Compliance will act as a strategic advisor to the President/CEO. As a senior leader in the organization, the General Counsel will direct the legal affairs of MVP Health Plan and its affiliated subsidiaries and provide legal guidance for matters related to the conduct of business by MVP. The General Counsel will be a member of the President’s Council, the senior executive leadership team at MVP, and will report periodically to the Board of Directors.  The General Counsel &; Senior Leader, Government Affairs & Compliance will act as a strategic advisor to the President/CEO. As a senior leader in the organization, the General Counsel will direct the legal affairs of MVP Health Plan and its affiliated subsidiaries and provide legal guidance for matters related to the conduct of business by MVP. The General Counsel will be a member of the President’s Council, the senior executive leadership team at MVP, and will report periodically to the Board of Directors.
 
Management Responsibility:
The General Counsel &; Senior Leader, Government Affairs & Compliance will have responsibility for overseeing the Legal, Government Affairs, and Compliance functions of the health plan. The Compliance function includes all compliance activities, HIPAA security compliance, and the special investigations unit. The position will provide day-to-
day oversight, coordination, and mentoring for an existing team of 30+ individuals.
 
Functional Responsibilities:
• Directs the activities of the Legal Department, including the management of staff attorneys, legal assistants, and
support staff.
• Assigns projects to appropriate attorneys, reviews attorney work product and ensures the quality of work emanating
from the Legal Department.
• Mentors and develops the managed care capabilities of staff attorneys.
• Directs the interviewing and selection of Legal Department staff.
• Provides management of the Legal staff, including orientation, training, performance management, counseling and
disciplinary action as needed.
• Handles policy and employee issues in conjunction with Human Resources.
• Advises and counsels management and Board on corporate law matters, including Board activities, employee
relations, real estate, and general legal issues. Represents MVP before regulatory agencies. Oversees the
development, implementation, and maintenance of MVP’s Corporate Compliance Program, as well as MVP’s efforts
related to HIPAA.
• Provides advice and counsel to the President/CEO on strategic initiatives and regarding all legal and business-
related matters, as required. Provides advice and counsel to the Board of Directors as appropriate.

• Advises and counsels the President/CEO and appropriate senior management regarding strategies for achieving
marketable, cost-effective, and stable physician networks. Communicates with key physician leaders or their
representatives as appropriate.
• Advises and counsels senior management in the development of negotiating strategies for network and risk
arrangements, including IPA and value-based care arrangements.
• Provides legal guidance with respect to risk constructs and appropriate provider structures capable of contracting
with MVP.
• Participates in negotiations as needed.
• Ensures that provider/network agreements are documented and secures any required regulatory approvals.
• Provides legal guidance during and after the implementation of new arrangements.
• Ensures ongoing compliance with existing contractual arrangements.
• Advises and counsels senior management regarding the development of new HMO, Insurance, and ERISA-based
lines of business. Oversees the review process for Department of Insurance and other regulatory reviews for new
products, new riders, etc. Ensures the timely drafting and submission of necessary forms for regulatory review.
Participates with Finance regarding premium rating issues, especially as related to regulatory approval of rate filings.
• Advises and counsels senior management on legal aspects of provider contracting, including hospitals/facilities,
laboratories, ancillary providers, and risk arrangements. Manages the regulatory review process, as required, for
provider contract approvals. Ultimately responsible for securing appropriate regulatory approvals.
• Advises and counsels on negotiation and management of agreements with 3rd party vendors, including MVP’s
mitigation of risk associated with 3rd party activity.
• Develops and manages legal, government affairs, and compliance department budget.
• Management of outside counsel and litigation.
• Provides leadership for the Corporate Compliance Officer (CCO) in auditing and monitoring of Medicare operations
to assess compliance with CMS Part C and Part D program requirements.
• Has oversight for audit findings and related communications, observations, and process improvements and for the
annual Medicare compliance auditing and monitoring work plan.
• Assures CCO and compliance team work collaboratively with business owners to develop impactful corrective
actions that appropriately address non-compliance identified through audits, monitoring or compliance reports.
• Assures monitoring and implementation of corrective actions by appropriate MVP business owners are done timely
to confirm resolution of Medicare compliance issues (e.g., reports, audit findings, metrics).
• Represents MVP on the Health Plan Association of NY, (HPA), and Government Affairs Committee to monitor NY
State health care law developments. Reviews proposed and new legislation to determine the impact on MVP and to
recommend the MVP position. Interacts with regulators and legislators in a group and on an individual basis to
advocate MVP’s and the industry’s position.
• Attends community and business events representing MVP Health Care.
• Oversees State (currently NYS and VT) and Federal Government Affairs strategy, communications and
relationships to help advance the organization’s priorities, mission, vision and values.
• Provides strategic direction for organizational priorities, strategy and advocacy on Government Affairs matters.
• Maintains external relationships with legislators, regulators and Government staff.
• Supervises Government Affairs staff, including Managers, Coordinator, and Administrative Assistant and provides
oversight as needed for the following functions: internal and external communications regarding Government Affairs
developments; relationships with third-party lobbyists and consultants; representation of the organization with industry
trade associations on Government Affairs matters.
• Ensures corporate compliance with campaign finance and ethics laws.
• Manages responses to Government Affairs inquiries regarding constituent matters. Represent the company at
external events involving legislators, regulators and staff.
• Oversees internal campaign finance fundraising and political action committee (PAC) communications.
• Provides community, public affairs, and media relations support as needed.
• Supports internal business units, as needed and appropriate, with compliance and strategy related to new laws,
regulatory developments, and Government Program needs.
• Maintains confidentiality and adhere to regulatory compliance issues as they exist and change from time to time.
Performs other related duties as assigned.

Qualifications:

Minimum Education:
J.D. degree from an accredited institution; Concentration in health law, or subsequent education in the health law
field, is desirable
 

Minimum Experience:
15+ year’s legal experience corporate generalist legal experience with a focus in health law/insurance
Deep expertise in health law with substantial experience in a managed care or health insurance company
Experience leading and managing a sizeable team at a health insurance or related health care company
 
Required Skills:
• Exceptional business acumen and ability to act as a strategic business advisor
• Well-versed in current industry policy issues with an understanding of how to effectively utilize lobbyist resources
• Ability and desire to significantly contribute to corporate initiatives both from a legal and a business perspective in
collaboration with the CEO and COO
• Ability to develop and mentor a team of experienced direct reports
• Ability to mobilize in-house resources for advocacy on behalf of the company
• Excellent interpersonal and communication skills with ability to influence others
• Innovative thinker who embraces change and can drive it
• A desire to facilitate “highest and best use” of legal advisors to drive MVP’s business objectives

To Apply:

Go to https://www.mvphealthcare.com/careers/?utm_source=radio_redirect&utm_medium=redirect&utm_campaign=aep_2018  

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