Staff Attorney (Remote NC)

Staff Attorney

Location: Remote – This is a home based position, but the incumbent must live in or near Vaya's catchment and must have the ability to travel or come to the office if needed. The person in this position is required to maintain residency in North Carolina or within 40 miles of the North Carolina border.

General Statement Of Job

As a member of the Vaya Health Legal Team, the Staff Attorney is responsible for assisting the General Counsel/Chief Compliance Officer and the Deputy General Counsel with the management of legal risk to the organization. Under the supervision of the Deputy General Counsel, the Staff Attorney will engage in broad array of legal work, including: (1) drafting, negotiating, and reviewing contracts with vendors and healthcare providers; (2) representing the organization in administrative and litigation matters, (3) providing day to day legal advice and counsel to Vaya Health staff concerning a wide range of legal issues, as assigned; (4) assisting in mitigating legal risk to the organization, including through managing Vaya Health insurance policies and serving as the legal representative on assigned committees, workgroups, and project teams; (5) researching, reviewing, evaluating, and analyzing federal and state laws, rules, and regulations pertaining to assigned subject matters for the organization; (6) reviewing and revising internal policies, procedures, business processes and templates, as assigned; and (7) supervision of a Legal Department manager, and providing appropriate oversight over the operations of the assigned manager's team.

Essential Job Functions

Legal Specific Work

Transactional Law: Under the supervision of, and as assigned by, the Deputy General Counsel,

• Develops, drafts, and negotiates contracts with vendors, healthcare providers, and entities affiliated with or representing healthcare providers.
• Reviews, analyzes, and advises internal business owners and interested parties on contracts and proposals presented to the organization by vendors.
• Supports the Contracts Team in managing the development, execution, organization, storage, and tracking of vendor and provider contracts.
• If assigned, assists the Deputy General Counsel in providing training to the Contracts Team on the management, negotiation, and development of provider and vendor contracts.
• Regularly interfaces with the Contracts Team, the Information System Division, and other business units to successfully negotiate assigned contracts with vendors.
• Liaises with and maintains professional working relationships with existing and prospective vendors, including subcontractors.
• Advises, reviews, and approves contracts drafted and/or negotiated by the Vendor Management Director and Contracts Manager(s).
• Drafts correspondence and notices of termination or breach to contractors relating to claims, defenses, or disputes arising under a contract.
• Assists with the regular distribution and tracking of contracts managed by the Contracts Team.
• Assists the Contracts Team with the management of special procurement projects, requests for proposal, and other contract projects as directed or assigned by the General Counsel/CCO, Deputy General Counsel, or the Executive Leadership Team.
• Assists the Legal and Contracts Teams with the development of contract templates and contract-related forms.
• Assists with updating the electronic contracts lifecycle management system and other software tools that may be used to develop, organize, and archive contracts and other documents relating to the contracting function, and tools that may be used to report on contracting activities.
• Provides legal advice and counsel to staff relating to the contracting and procurement functions.
• Assist other Vaya legal counsel, paralegal, the Contracts Team, and the Compliance Department with review, response, and preparation of documents, reports, or correspondences.

Research, Consultation and Documentation Review: Under the supervision of the Deputy General Counsel, and as assigned by the General Counsel/CCO or Deputy General Counsel,

• Interprets and maintains working knowledge of federal and state laws, rules, regulations, court decisions, policy guidance, accreditation standards, contracts, guidance, and other legal or regulatory authorities affecting the organization, including, but not limited to, compliance as a LME/MCO and with its Behavioral Health and Intellectual/Developmental Disabilities Tailored Plan, Medicaid Direct PIHP, and other health plan operations.
• Conducts fact gathering and legal research and prepares memorandums of law on complex issues as requested by the General Counsel/CCO, Deputy General Counsel, or a Senior Associate General Counsel
• Assists in developing staff training, education and written guidance on legal matters affecting the organization.
• Serve as legal representative on designated internal committees or work groups

Litigation and Litigation Risk Management: Under the supervision of the Deputy General Counsel, and as assigned by the General Counsel/CCO or Deputy General Counsel,

• Assists in the handling of member appeals, provider appeals, litigation, subrogation liens, and collections.
• Assists in providing legal representation to the organization in member and recipient mediations (when needed), state administrative hearings, and other administrative or civil litigation matters.
• Prepares drafts and final responses to pleadings, motions, discovery, and other legal documents pertaining to legal matters involving the organization.
• Works closely with the Deputy General Counsel to determine the merits of a case, develop case strategy, perform legal research, and develop legal arguments, evidence, witness lists, and examination and cross-examination questions in preparation for litigation.
• Prepares employees for depositions and court appearances.
• Provides legal advice and counsel to staff regarding disputes with providers, vendors, or other stakeholders that may lead to litigation or required for mitigation of legal risk to the organization.

Other Duties as Assigned

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.

Knowledge, Skills, & Abilities

• Strong understanding of the managed care industry; and experience with Medicaid Managed Care, preferred.

• Superior analytical and critical thinking skills, excellent negotiation skills, a strong work ethic, good judgment, and an ability to maintain confidentiality and compliance

• Able to establish and maintain effective working relationships with internal and external stakeholders, as well as ensure direct reports are doing the same.

• Provide oversight of both clinical and administrative quality improvement projects, applying performance excellence techniques and methodology.

• Demonstrated skills and experience in collaborative, strategic and analytical thinking.

• Strong interpersonal skills and demonstrated ability to lead teams in an effective and impactful manner.

• Must be knowledgeable about the rule This position should require little direct supervision. A high level of diplomacy and discretion is required to effectively negotiate and resolve issues with minimal assistance. This will require exceptional interpersonal skills, highly effective communication ability, and the ability to make prompt, well- reasoned decisions based upon relevant facts.

• Problem solving, negotiation, arbitration and conflict resolution skills are essential. Ability to maintain effective working relationships and to work objectively and impartially with individuals representing various departments, issues or views.

• Working knowledge of administrative law and experience with the NC Office of Administrative Hearings required.

• Experience representing health plans, insurers, and/or health care providers and working knowledge of NC Medicaid program, Medicaid managed care programs and/or Medicare program required.

• Experience interacting with NC Department of Health and Human Services, the Centers for Medicare and Medicaid Services and/or the Office of Inspector General preferred.

• Ability to conduct administrative and civil litigation. Ability to interpret and apply constitutional provisions, statutes, administrative regulations, court decisions, and other precedents, and to analyze facts, evidence, and legal instruments. Ability to express conclusions and arguments clearly and logically in oral and written form.

• Good judgment and analytical skills.

• Overall broad legal knowledge (contracts, litigation, managed care).

• Working knowledge of, or ability to quickly learn, how the organization operates.

• Proficiency in Microsoft Office products (such as Word, Excel, Outlook, PowerPoint, etc). Must have valid NC driver's license and be able to provide own transportation in conduct of work assignments; willingness to travel as needed. Must be able to use computers, copiers, scanners and other office equipment that will be used routinely.

Qualifications & Education Requirements

A Juris Doctor Degree from an ABA accredited law school is required. One to three years of progressively responsible professional legal experience is required. General practice or health law experience in managed care, government, or law firm setting, in or near the Raleigh area is preferred.

Licensure/Certification Requirements

Being licensed as an attorney in good standing in North Carolina is a requirement.

Physical Requirements

Close visual acuity to perform activities