Healthcare Counsel

This is a remote position available in the following states: AK, AR, AZ, CO, FL, HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NE, NV, NM, NC, ND, OK, OR, SC, SD, TN, TX, UT, VA/DC, WA, WI, and WY. The role requires working regular business hours in Arizona Time. Due to our Department of Defense contract, US citizenship and a favorably adjudicated DOD background investigation are required. Veterans, Reservists, Guardsmen, and military family members are encouraged to apply.

About the Role

Supports the Office of General Counsel in advising and producing attorney work products that support TriWest’s healthcare-related departments, including Provider Services, Medical Management, Program Integrity, and Claims. The candidate will draft, review, and negotiate contracts with providers and other organizations to achieve acceptable risk levels. Additional responsibilities include supporting legal and regulatory communications with providers and outside parties, participating in litigation management, and addressing legal and regulatory research needs.

TriWest prioritizes candidates with experience in healthcare regulatory matters, including Medicare, Medicaid, conditions of participation in federal healthcare programs, anti-kickback laws, self-referral laws, HIPAA, and transactional matters for healthcare providers.

Requirements

• Juris Doctor degree from an accredited law school
• License to practice law in the state where legal services will be primarily provided
• U.S. citizenship
• Ability to receive a favorable Interim and adjudicated final Department of Defense (DoD) background investigation
• 2+ years of healthcare regulatory/transactional legal experience
• Excellent written and verbal communication skills
• Experience advising managed care administrators, health plans, or healthcare providers
• Familiarity with HIPAA, False Claims Act, Stark, Anti-Kickback, and other healthcare-related laws and regulations

Preferred Qualifications

• Familiarity with government-funded healthcare programs
• Familiarity with VA and DoD healthcare programs
• Prior experience with federal government contracting
• Experience reviewing, drafting, and negotiating provider agreements

Responsibilities

• Identifies and analyzes legal issues, including conducting legal research and identifying emerging areas of risk, presents clear recommendations, and ensures legal compliance.
• Investigates, researches, and provides general legal advice on a broad range of issues arising from TriWest’s healthcare operations.
• Reviews and negotiates documents and contracts, including provider agreements, business associate agreements, and transactions involving electronic health records and telehealth.
• Assists in providing legal advice to departments and committees on health law issues, including fraud and abuse, privacy and security, and peer review privilege.
• Drafts and reviews miscellaneous legal documents and correspondence.
• Researches current issues and developments related to government healthcare programs, health insurance, and the impact of existing and proposed healthcare regulations.
• Performs legal research and prepares memoranda on assigned legal issues.
• Assists with the development and monitoring of internal regulatory compliance procedures.
• Reviews marketing materials, responses to grievances, routine and priority correspondence, and internal and external communications documents.
• Supports legal functions for TriWest standing and ad hoc committees, including those responsible for peer review, quality, and credentialing programs.
• Reviews and revises Company policies and procedures as required.
• Ensures Company employees and committee members are aware of and in compliance with applicable laws and regulations.
• Educates staff and committee members on legal requirements as appropriate.
• Advises TriWest leadership on the legal ramifications of past and proposed company actions.
• Performs other duties as assigned.
• Regular and reliable attendance is required.

Skills

• Coaching / Training / Mentoring: Actively fosters actions required for desired business outcomes through ongoing constructive feedback.
• Communication / People Skills: Ability to influence or persuade others under positive or negative circumstances; adapt to different styles; listen critically; collaborate.
• Computer Literacy: Ability to function in a multi-system Microsoft environment using Word, Outlook, TriWest Intranet, the Internet, and department software applications.
• Empathy / Customer Service: Customer-focused behavior; helping approach, including listening skills, patience, respect, and empathy for another's position.
• Independent Thinking / Self-Initiative: Critical thinkers with the ability to focus on things that matter most to achieving outcomes; commitment to task to produce outcomes without direction and to find necessary resources.
• Information Management: Ability to manage large amounts of complex information easily, communicate clearly, and draw sound conclusions.
• Organizational Skills: Ability to organize people or tasks, adjust to priorities, learn systems within time constraints and with available resources; detail-oriented.
• Problem Solving / Analysis: Ability to solve problems through systematic analysis of processes with sound judgment; has a realistic understanding of relevant issues.
• Technical Skills: Proficiency in Microsoft Office (Word, Excel, Outlook).

Working Conditions

• Availability to work non-regular hours as necessary
• Works within a standard office environment, with minimal travel
• Extensive computer work with prolonged periods of sitting

About the Company

TriWest Healthcare Alliance is dedicated to taking care of our nation’s heroes by connecting them to healthcare in the community. Since 1996, we’ve been on a mission to serve those who served.

Benefits

• Medical, Dental, and Vision Coverage
• Paid time off
• 401(k) Retirement Savings Plan (with matching)
• Short-term and long-term disability, basic life, and accidental death and dismemberment insurance
• Tuition reimbursement
• Paid volunteer time

Pay

This position ranges from around $142,000 to $149,000 per year.