LOCATION: Applicants need to live in North Carolina. The position can be remote, but the applicant must be able to travel to Vaya's main office in Asheville, NC, to Raleigh, NC for hearings at OAH, and within Vaya's Catchment Area and to the various Vaya Counties as needed.
GENERAL STATEMENT OF JOB
Serving as a member of the General Counsel and Chief Compliance Officer's leadership team, the Deputy General Counsel manages the Vaya Health Legal Department and is responsible for providing a wide range of legal advice and counsel to Vaya leadership and business units and managing legal resources in a manner that supports Vaya's mission, vision, and values, including Vaya's focus on creative and responsive problem-solving and meaningful engagement with community stakeholders. The Deputy General Counsel provides a proactive, highly strategic, and collaborative approach to legal issues and develops solutions that balance ethical and prudent legal advice with effective risk assessment and that are responsive to external and internal needs in a complex public organization.
Note: This position requires access to and use of confidential healthcare information or protected health information (PHI) as described in laws addressing patient confidentiality, including, but not limited to, the federal HIPAA law, the Confidentiality of Substance Use Disorder Patient Records laws and regulations codified at 42 U.S.C. *290dd-2 and 42 CFR Part 2, and various state laws. As such, the individual filling this position shall be required to be trained regarding such laws and shall be required to observe those laws in his/her capacity as an employee of Vaya Health. The individual filling this position shall also sign a confidentiality statement as an employee of Vaya Health.
Essential Job Functions
Direct supervision, oversight, and management of the Vaya Health Legal Department, including the Vendor Management Team
- Manage the Legal Department and supervise staff and attorneys within the department (currently including but not limited to a Senior Associate General Counsel, two Assistant General Counsels, a Contracts and Vendor Management Director, a Member Appeals Manager, and a Records Manager), consistent with Vaya Health policies and procedures.
- Prepare and administer the Legal Department's annual operating budget.
- Serve as the senior legal advisor on the BH and I/DD Tailored Plan and NC Medicaid Direct, including interpretation of NC Department of Health and Human Services requirements, advice and recommendations for implementation and deliverables, interfacing with representatives of NCDHHS, and negotiation of amendments to the Tailored Plan and Medicaid Direct contracts.
- Serve as the clearinghouse for all requests for legal assistance from Vaya staff. Determine if requests for legal assistance shall be handled internally or referred to outside counsel and delegate appropriately. If referred to outside counsel, supervise and monitor such engagements.
- Provide professional and authoritative legal and policy advice relating to all legal matters impacting Vaya, including but not limited to contracts, organizational governance, labor and employment matters, privacy and security, healthcare regulation, intellectual property, information technology, tax, insurance, real estate, procurement, purchases and sales, strategic alliances, new ventures, legislative and regulatory affairs, legal research, litigation, hearings/ court appearances, subpoenas, member/recipient and provider appeals, and other areas as needed.
- Assist and advise the Compliance Department, Chief Information Security Officer, and Privacy Officer on legal issues related to compliance, audits, program integrity activities, investigations, enforcement, and sensitive information laws, including HIPAA, 42 CFR Part 2, and other federal and state confidentiality laws, rules, and regulations.
- Determine and recommend appropriate course of action for dispute resolution, including but not limited to: reviewing sensitive/ high-risk complaints and grievances; providing advice on Vaya's internal dispute resolution processes and reconsideration decision notices; evaluating cases where Vaya is a party or has a potential interest in all external legal forums, e.g., juvenile, guardianship and involuntary commitment proceedings, state administrative hearings, state district and superior courts; responding to subpoenas; and making court appearances, assigning staff attorneys to such appearances, or engaging outside counsel as needed to represent Vaya's interests.
- Manage outside counsel and litigation, and, in appropriate situations, prepare pleadings, briefs and other legal memoranda as needed to represent Vaya Health in court proceedings and before administrative hearing bodies. Assist General Counsel with legal spend management and oversight as appropriate, including matter management and relationships with and engagement of outside counsel.
- Provide advice to and/or communicate with staff, courts, clerks and other county officials regarding court-ordered forensic evaluations and multidisciplinary evaluations, involuntary commitments of adults and minors, dispositions of youths in juvenile court, guardianships, and other such matters and programs.
- Assist with government affairs and other public functions and events, including communications with members of the NC General Assembly and county commissioners regarding proposed bills or legislation impacting Vaya Health, its members and recipients and/or the public healthcare system; appearance at legislative hearings and member, provider and stakeholder forums upon request; attending meetings of Vaya's Board of Directors and Regional Boards upon request; and other events involving Legal Department functions or staff.
- Advise and recommend policy and procedure changes based on current or emerging case law and precedent and assist Vaya business units in the development, preparation and review of related policies and procedures and other written deliverables (e.g., Tailored Plan deliverables, program descriptions, plans and reports).
- Identify and monitor potential legal issues, provide guidance, and develop solutions that reduce risk and result in a prudent legal position.
- Maintain current knowledge of applicable legal/ caselaw, statutory, regulatory, and sub-regulatory developments in relation to Vaya's operations and the overall healthcare marketplace.
- Assist, advise and handle a variety of healthcare regulatory matters, including researching ad hoc issues, helping the Waiver Contract Manager respond to legislative and regulatory inquiries, addressing legal inquiries and matters from the Department and other entities.
- Supervise, coordinate and/or handle public records requests as needed.
- In addition to oversight of legal functions, oversee the member and recipient appeals team (reporting to the Senior Associate General Counsel) and the procurement and contracting function (the Contracts Team). The appeals team ensures the timely, clinically appropriate, and legally sound resolution of all member and recipient appeals under the current BH I/DD Tailored Plan and Medicaid Direct PIHP Plan. The Contracts Team is responsible for coordinating with internal business units to obtain, review, interpret, draft, negotiate, and ensure timely execution of all Vaya contracts and written agreements, including preparation of contract templates. In collaboration with the Compliance Department, the Contracts Team also monitors vendors performing delegated functions and serves as a key component of the Vendor Oversight Committee.
KNOWLEDGE OF JOB
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Knowledge, Skills And Abilities
- This position requires little direct supervision and a high level of diplomacy and discretion to effectively negotiate and resolve issues with minimal assistance.
- Exceptional interpersonal skills, highly effective communication ability, excellent judgment, strong work ethic, superior analytical and critical thinking skills, and excellent problem solving, negotiation, arbitration and conflict resolution skills are essential.
- Ability to establish and maintain effective, positive working relationships with staff, other members of the organization, court personnel, regulators, public, stakeholders and other persons contacted in the course of work, and to work objectively and impartially with individuals representing various departments, issues, or views.
- Demonstrated ability to effectively work in a complex healthcare environment in a highly collaborative manner keeping all stakeholders informed as appropriate.
- Knowledge of and ability to interpret, analyze, understand, apply, and complete tasks related to relevant state and federal cases, statutes, regulations, rules, common law, and other legal authorities, particularly as it relates to publicly funded managed healthcare services in North Carolina and the Medicaid program.
- Detail oriented with excellent organizational skills, including ability to manage multiple schedules and tasks, and ability to anticipate and timely meet deadlines and projects.
- Ability to conduct and/or supervise appearances and civil litigation in administrative and trial courts and other forums regarding Medicaid appeals, juvenile justice, involuntary commitment, guardianships, and related matters.
- Ability to make prompt, well-reasoned decisions based upon relevant facts.
- Ability to analyze facts, evidence, legal instruments, and legal problems and render formal opinions.
- Ability to interpret and apply constitutional provisions, statutes, laws, rules, regulations, court decisions, and other precedents, and to analyze facts, evidence, and legal instruments.
- Ability to communicate clearly, effectively, and persuasively, including logical conclusions and arguments, both orally and in writing.
- Ability to analyze, interpret, draft, and recommend policy and procedural guidelines.
- Ability to maintain total confidentiality and compliance with the professional responsibility rules and ethical code for attorneys.
- Ability to manage and uphold integrity and confidentiality of sensitive information and data, internally and externally.
- Overall broad legal and litigation knowledge (including but not limited to contracts and other transactional matters), thorough knowledge of judicial and quasi-judicial procedures and the rules of evidence, familiarity with practices and requirements applicable to NC unit of local government/ public authority, and knowledge of the principles, techniques and procedures of public policy research and analysis.
- Proficiency with law-related software and database resources and proficiency in Microsoft Office products (such as Word, Excel, Outlook, PowerPoint, etc.), including the ability to design reports and presentations for internal and external recipients. Must be able to use computers, copiers, scanners, and other office equipment that are used routinely.
- Must have valid NC driver's license and be able to provide own transportation in conduct of work assignments; willingness and ability to travel as needed to perform job duties (position is remote but applicant should reside in North Carolina with ability to travel to Raleigh, NC and counties served by Vaya Health).
Qualifications & Credentialing Requirements
- Graduation from an ABA accredited School of Law
- At least seven years of progressively responsible professional legal experience in healthcare, managed care, public benefits law, or some combination thereof
- Extensive knowledge of federal and state Medicaid program including Medicaid waivers, BH and I/DD Tailored Plan, public healthcare services and delivery system in North Carolina, related state and federal regulations, the Centers for Medicare and Medicaid Services (CMS), and NC Medicaid Managed Care required.
- Extensive knowledge of administrative law and experience with the NC Office of Administrative Hearings required.
- Experience in-house at or for public/governmental entity; in a behavioral health and/or managed care environment; and/or representing parties in NC administrative tribunals and district/superior courts strongly preferred.
- Experience interacting with NC Department of Health and Human Services, CMS and/or the U.S. HHS Office of Inspector General preferred.
Licensure & Certification Requirements
- Actively licensed as an attorney in good standing in North Carolina.
Physical Requirements
Close visual acuity to perform activities such as preparation and analysis of documents; viewing a computer terminal; and extensive reading. Physical activity in this position includes crouching, reaching, walking, talking, hearing and repetitive motion of hands, wrists and fingers. Sedentary work with lifting requirements up to 10 pounds, sitting for extended periods of time. Mental concentration is required in all aspects of work.
RESIDENCY REQUIREMENTS: The person in this position is required to reside in North Carolina or within 40 miles of the NC border.
SALARY: Depending on qualifications & experience of candidate. This position is exempt and is not eligible for overtime compensation.
DEADLINE FOR APPLICATION: Open until filled
APPLY: Vaya Health accepts online applications in our Career Center, please visit https://www.vayahealth.com/about/careers/.
Vaya Health is an equal opportunity employer.
Required
Preferred
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