Description:

Summary:
The Vice President, Deputy General Counsel will report to the Executive Vice President, General Counsel of AmeriHealth Caritas. The Deputy General Counsel will assist in the development and implementation of comprehensive and proactive legal solutions on a range of matters impacting the organization. Responsible for providing overall leadership and management of a team of attorneys and/or other legal professionals. Strong understanding and experience in some or all of the following areas: Medicare Advantage and dual eligible Medicare/Medicaid plans; ACA/exchange programs; insurance; health care regulations; E-Privacy, data, HIPAA and security; healthcare/insurance regulations, provider ancillary and vendor contracts. Assists General Counsel in providing legal advice and services on significant matters that impact the overall organization and helps to set and drive the strategic direction for the Legal department.

Federal Government Programs and Risk Mitigation: This role will provide oversight, leadership, support and counsel on any and all legal issues related to Medicare Advantage, D-SNP, Part D, ACA/Exchange, litigation, and risk mitigation. This includes all types of healthcare regulatory risk mitigation, general commercial and employment litigation, while ensuring effective and efficient resolutions across the AmeriHealth Caritas Family of companies (ACFC).

Work Arrangement: Remote with required travel as needed

Responsibilities:

Provide advice and counsel on Medicare Advantage, Medicare Part D, EGWP, DSNP, Medical Services Organization, Individual Family Plans (ACA), federal regulatory support and Medicare supplemental benefits.
Partner within the department and with business clients to provide advice and counsel on Medicare Advantage and ACA new product design, regulatory and audit support, review of complex care management and value-based arrangements, sales/broker contracting oversight.
Partner with Government Affairs, Compliance, Provider Contracting, National Ancillary, Privacy, and Finance on all matters related to Medicare Advantage, ACA and all material litigation matters.
Provide advice and counsel for all federal proposed, and new rules, laws, and regulations impacting the ACFC lines of business.
Served as legal subject matter expert for significant Medicare and ACA related initiatives to mitigate risk related to the Anti-Kickback Statute, the False Claims Act, and other enforcement risks.
Oversee all company litigation matters, including commercial, employment, anti-trust, and federal and state regulatory inquiries
Develop and implement litigation and risk management strategies that align with ACFC's business objectives, mitigate risk and protect the company's brand and business
Actively lead the legal strategy related to complex federal, state, and local regulatory and investigatory matters and litigation.
Actively lead and develop a team of professionals dedicated to supporting all ACFC's lines of business and functional areas related to the above outlined matters.
Manage and oversee external legal counsel including managing budgets, directing litigation and investigation strategies, reviewing, and finalizing pleadings, mediation/arbitration statements, and settlement agreements, and ensuring cost-effective and high-quality legal representation.
Effectively build and strengthen relationships with colleagues at all levels across the organization to understand the business issues and effectively manage legal risk.
Provide legal counsel and guidance to executive leadership on litigation risks.
Protect and represent the organization's interests in disputes, settlements, and litigation.
Develop and maintain relationships with key government regulatory authorities.

Education:

A Juris Doctorate Degree with a current and valid license to practice law in a U.S. jurisdiction with the ability to obtain applicable in-house counsel admission(s)
A minimum of 12 years of post-law licensure experience with progressive and expanding scope of practice, management, and leadership experience

Experience:

Strong understanding and experience in the following areas: Medicaid managed care; pharmacy benefit management; behavioral health; Medicare Advantage; Health Insurance Exchange health plans; state and federal government programs managed care, privacy, security, and insurance statutes and regulations; healthcare/insurance corporate transactions, complex contract negotiations, regulator communications, legal support for both existing markets and products and acquisition/implementation of new markets, and dispute resolution.
Demonstrated integrity, sound judgment, and strong interpersonal skills, fostering a collaborative and transparent work environment.
Proven ability to manage multiple projects, work independently, and thrive in a fast-paced setting. Exceptional communication skills with a track record of advising senior management as a strategic legal partner.