Description:

Pay Transparency:
The above reflects the anticipated annual salary range for this position if hired to work in New Jersey.

The compensation offered to the candidate selected for the position will depend on several factors, including the candidate's educational background, skills and professional experience.

Assistant General Counsel, Managed Care and Regulatory
Job Overview:
RWJBarnabas Health, New Jersey's largest integrated academic healthcare system, seeks an experienced, detail-oriented, and strategic in-house attorney to serve as Assistant General Counsel, Managed Care and Regulatory.This role will focus on legal matters involving managed care and payer contracting, value-based reimbursement models, population health initiatives, preferred provider arrangements, the 340B Program and other regulatory and compliance matters.The successful candidate will provide legal and business guidance on complex contractual and regulatory issues relating to payor relationships, third-party administrators, Medicare Advantage, Medicaid Managed Care, Medicare and Medicaid reimbursement, population health initiatives relating to the system s clinically integrated network and other value-based initiatives, as well as on other regulatory and compliance matters, including 340B. This position requires at least 15 years of relevant legal experience, preferably within a large, non-profit academic health system. The Assistant General Counsel, Managed Care and Regulatory serves as a senior member of the RWJBarnabas Health Office of General Counsel. This role advises system leadership, clinical and administrative teams, and compliance professionals on managed care and population health contracts, initiatives and disputes; federal and state healthcare regulations; reimbursement matters; pharmacy and 340B program requirements; fraud and abuse laws and nonprofit/tax-exemption requirements. The Assistant General Counsel, Managed Care and Regulatory works closely with other members of the Office of General Counsel, Managed Care, Population Health, Compliance & Internal Audit, Pharmacy, Business Development, Finance & Reimbursement, and various business stakeholders to support system operations and strategic initiatives and the system's mission to provide high-quality patient care while mitigating legal and regulatory risk.

Location: West Orange, New Jersey

Reports To: SVP/Deputy General Counsel

Qualifications:

Juris Doctor from an accredited law school.
Admission to the New Jersey Bar or eligibility for limited in-house license.
Minimum 15 years of legal experience, with a strong preference for candidates with experience at a non-profit academic healthcare system.
Deep expertise in managed care contracting, value-based payment models and risk arrangements, preferred provider networks, clinically integrated networks and accountable care organizations and regulatory frameworks governing provider-payer relationships.
Strong knowledge of laws and regulations pertinent to nonprofit health systems.
Experience with reimbursement, fraud and abuse, and healthcare compliance matters.
Familiarity with pharmacy regulations and 340B program compliance.
Demonstrated ability to negotiate high-stakes contracts with a strong grasp of both legal risk and business priorities.
Excellent verbal and written communication skills, with the ability to convey legal complex concepts to non-lawyers.
Attention to detail, with a proactive and collaborative work style.
Prior in-house counsel experience at a health system, hospital, or academic medical center strongly preferred; healthcare regulatory law firm experience also considered.
Ability to interpret complex regulations and provide practical, business-focused advice, strong leadership, communication.

Essential Functions:
Contract Drafting, Negotiation, and Review:

Draft, negotiate, and review a broad array of managed care, value-based and population health-related contracts, including commercial and government payor agreements, provider network participation agreements, third-party administrator contracts, delegated credentialing agreements, CIN participation agreements, preferred provider arrangements, contract pharmacy arrangements and related contracts.
Advise on contract language interpretation and strategic terms related to reimbursement, risk-sharing, quality performance metrics, dispute resolution, and termination rights.
Coordinate closely with managed care, revenue cycle, finance, population health, compliance, pharmacy and operational leadership teams to ensure alignment with system goals and financial impact.

Regulatory and Legal Compliance:

Monitor and interpret federal and state regulatory developments affecting managed care, population health, preferred provider arrangements, and 340B arrangements, including but not limited to ERISA, HIPAA, the No Surprises Act, CMS guidance, applicable fraud and abuse laws, 340B requirements, and New Jersey-specific legal requirements.
Ensure that contracts, and payor and population health and 340B strategies remain in compliance with all applicable laws and regulations.
Provide legal counsel on a wide range of regulatory and compliance matters, including:
Medicare, Medicaid, and commercial payor reimbursement rules.
Federal and state fraud and abuse laws including the Stark Law, Anti-Kickback Statute, False Claims Act and similar state laws.
Pharmacy and 340B Drug Pricing Program compliance.
Telehealth, digital health, and emerging care delivery models.
Nonprofit and tax-exemption laws affecting healthcare systems, including IRS 501c3 compliance, community benefit, and private information to academic medical centers and non-profit health systems.

Internal Legal Support and Business Strategy and Litigation Strategy:

Advise on value-based care models, alternative payment arrangements and population health and preferred provider initiatives in accordance with fraud and abuse laws, including, without limitation, the federal Anti-Kickback Statute, Stark Law, and state equivalents.
Participate in cross-functional teams focused on managed care strategy, payment innovation, population health initiatives, 340B compliance and operational implementation of contractual terms and applicable legal and regulatory requirements.
Keep up to date on and advise Managed Care, Population Health, Compliance & Internal Audit, Pharmacy, Business Development, Finance & Reimbursement, and various business stakeholders on new payor policies impacting the system.
Support payor and governmental audits, internal investigations, enforcement actions, and disclosures involving reimbursement, regulatory or tax-exemption matters.
Oversee and advise on legal disputes with payors relating to contracting matters and new payor policies and practices.
Support diligence, regulatory compliance, auditing and monitoring in connection with system joint venture arrangements and other strategic transactions and initiatives.
Collaborate with colleagues in Legal Affairs to ensure regulatory advice is integrated into contracts, governance, transactions, and other system initiatives.
Serve as a trusted advisor to system leadership, offering practical legal counsel that balances risk mitigation with business objectives.
Proactively identify areas of legal risk and propose creative, legally compliant solutions that promote health system initiatives and strategic partnerships.

Administrative and Team Responsibilities

Maintain accurate documentation and tracking of all managed care, population health and contract pharmacy agreements and associated legal files.
Provide training and education to internal stakeholders regarding contract provisions, regulatory changes, and negotiation strategies.
Contribute to departmental initiatives around process improvement, contract lifecycle management, and legal operations.

Other Duties:
Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

Additional Information:
Benefits And Perks:

At RWJBarnabas Health, our employees are at the heart of everything we do. Driven by our Total Wellbeing promise, our market-competitive offerings include comprehensive benefits and resources to support our employees' physical, emotional, financial, personal, career, and community wellbeing. These benefits and resources include, but are not limited to:
Paid Time Off including Vacation, Holidays, and Sick Time
Retirement Plans
Medical and Prescription Drug Insurance
Dental and Vision Insurance
Disability and Life Insurance
Paid Parental Leave
Tuition Reimbursement
Student Loan Planning Support
Flexible Spending Accounts
Wellness Programs
Voluntary Benefits (e.g., Pet Insurance)
Community and Volunteer Opportunities
Discounts Through our Partners such as NJ Devils, NJ PAC, and Verizon
….and more!

Choosing RWJBarnabas Health!
RWJBarnabas Health is the premier health care destination providing patient-centered, high-quality academic medicine in