Regulatory Counsel

Job Description

Job Description

The Counsel, Healthcare Regulatory, will serve as a resource for the Legal team, advising the corporate team and the network of affiliated and managed clinical practices on the healthcare regulatory framework and translating that framework into day-to-day operations, projects, and contracting. Substantive areas of work will include: (i) fraud and abuse counseling and arrangement structuring; (ii) health information privacy and security; (iii) professional and facility licensure, scope of practice, and corporate practice of medicine matters; and (iv) drafting and negotiating healthcare and commercial contracts across the network. The Counsel, Healthcare Regulatory, will support the Legal team in protecting the business' legal interests and maintaining operations within the scope established by law, and will provide hands-on, practical guidance to management and practice staff. The role reports to the VP, Associate General Counsel.

 

Responsibilities:

• Advise on healthcare regulatory matters, including the federal Anti-Kickback Statute, the Stark Law, the False Claims Act, and analogous state fraud and abuse and self-referral laws.
• Structure, paper, and document physician, vendor, and referral source arrangements to fit within applicable safe harbors and exceptions, and provide clear, written, decision-ready guidance where no safe harbor or exception is available.
• Review, draft, negotiate, and close healthcare and commercial contracts across the network, including physician employment and professional services agreements, medical director and coverage arrangements, vendor agreements, master service agreements, statements of work, research agreements, licensing agreements, and business associate agreements.
• Advise on HIPAA and state health information privacy and security requirements.
• Counsel practices and corporate stakeholders on professional and facility licensure, scope of practice, supervision and delegation, corporate practice of medicine and fee-splitting restrictions, and certificate of need requirements across the states in which the network operates.
• Monitor developments in federal and state healthcare law and agency guidance, and translate them into practical policies, playbooks, contract templates, and training for the business.
• Partner with the Compliance team on regulatory questions, internal reviews, and remediation, and support responses to payor and government inquiries as requested.
• Provide rapid, practical, business-oriented legal and contract guidance directly to stakeholders, and support business stakeholders in negotiating pricing, deliverables, services, and other commercial terms.
• Apply innovative problem-solving skills and practical business judgment to maximize revenues, minimize risk, and foster long-term clinical and business partner relationships.
• Identify complex issues requiring escalation to senior members of the Legal team.
• Collaborate with and facilitate cross-team decision-making among internal teams, including compliance, revenue cycle, operations, integrations, and human resources.
• Work with outside counsel on matters requiring discrete expertise when requested.
• Manage assigned projects to completion.
• Assist more senior counsel and management in higher level matters, as needed.
• Additional responsibilities as assigned to help drive our mission of improving the lives of everyone living with cancer.

 

Required or Preferred Qualifications:

• 5-7 years of relevant legal experience in a law firm or corporate legal department, with substantial healthcare regulatory work.
• Working knowledge of the federal Anti-Kickback Statute, the Stark Law, the False Claims Act, and analogous state laws, and demonstrated ability to apply them to real-world arrangements.
• Experience advising on HIPAA and health information privacy and security requirements.
• Familiarity with professional and facility licensure, scope of practice, and corporate practice of medicine and fee-splitting restrictions.
• Significant experience drafting and negotiating healthcare and general commercial contracts.
• Physician provider, physician practice management, or multi-site provider experience.
• Experience with Medicare and Medicaid enrollment, conditions of participation, and payor regulatory requirements.
• In-office dispensing, or pharmacy regulatory matters.
• Data and privacy experience, including de-identification, data rights, and software licensing agreements.
• Juris Doctorate from an accredited law school.
• Member of a state or DC bar.

 

Essential Competencies:

• Ability to distill complex regulatory matters into digestible formats; deliver clear regulatory analysis that gives business stakeholders a practical path forward, not simply a list of risks.
• Excellent verbal and written communication skills.
• Exceptional analytical and critical thinking skills.
• Demonstrated success working in a high-performing, results-driven environment.
• Strong work ethic and proven ability to draft and close agreements with minimal support from senior staff.
• Attention to detail and superior organizational skills.
• Demonstrated ability to think and decide quickly, and to communicate legal issues and solutions clearly and concisely.
• Highest standards of ethics, professional integrity, and discretion.
• Self-starter with the ability to work efficiently with minimal supervision.
• Ability to effectively and timely manage workflow, including multiple complex projects in a proactive and highly responsive manner.
• High degree of cultural and emotional intelligence, and demonstrated aptitude for resilience, flexibility, and ability to adapt to changing circumstances and dynamics.
• Recognizes the importance of collaboration and the value of a team mindset.

 

Pandologic. Keywords: Regulatory Affairs Consultant, Location: Nashville, TN - 37203 , PL: 604590952