Vice President and General Counsel - Peak Health

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Reporting to the SVP & Chief Legal Officer (CLO) of West Virginia University Health System (WVUHS) with a dotted line reporting relationship to the Peak Health President, the VP & General Counsel (GC) of Peak Health will be responsible for a broad range of legal work in support of Peak Health, which includes health plan and third-party administrator (TPA) services companies that are majority owned by Peak Health Holdings, a wholly-owned subsidiary of WVUHS in collaboration with other health system provider partners. The GC will be embedded into the Peak Health leadership team and will support Peak Health executive leadership in achieving Peak’s strategic objectives in a legally compliant manner, including expansion into highly regulated government health plan products. The GC is also responsible for other day-to-day duties related to Peak Health’s operations, including its Medicare Advantage plans and TPA services, as assigned by the CLO or President. The GC will be expected to build and maintain strong working relationships with the rest of the WVUHS legal team as well as the legal teams of Peak Health’s other provider owners.

MINIMUM QUALIFICATIONS :

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. Juris Doctor

2. West Virginia Bar membership or eligibility to obtain West Virginia Bar membership within one year of employment

EXPERIENCE:

1. At least 10 years of substantial experience in corporate, transaction, contract, and regulatory law in a law firm or in-house legal department. Direct experience in health insurance and managed care strongly preferred.

CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.

1. Prepares and reviews contracts and/or agreements between Peak Health and outside companies, agencies, or organizations.

2. Advises the Peak Health Provider Relations & Contracting Department on legal issues related to provider participation agreements, reimbursement, credentialing agreements, and payer-provider disputes.

3. Assists Peak Health’s Corporate Compliance and Privacy Officer, as needed, on compliance and privacy matters.

4. Stays current on trends in the law and, particularly, managed care, health insurance, corporate, transaction, corporate and health care law.

5. Provides day-to-day legal advice to Peak Health’s board of directors, officers, and employees regarding corporate governance and compliance with all applicable laws, including but not limited to managed care and health insuran ce regulations.

6. Is knowledgeable of legal trends and standards which regulate insurers and managed care companies and works to ensure Peak Health’s compliance with these standards.

7. Provides advice regarding compliance with Medicare and Medicaid fraud and abuse and tax issues.

8. Updates and revises articles of incorporation, bylaws, and related documents.

9. Provides advice regarding the development of policies and procedures.

10. Responds in a timely manner to requests for advice or information.

11. Provides legal support in the submission of regulatory filings to the WV Office of Insurance Commissioner, WV DHHR, and CMS.

12. Demonstrates regard for the dignity, respect, and safety of all Peak Health members, beneficiaries, and personnel.

13. Displays a caring and courteous attitude and represents such organizations in a positive manner to all persons 100% of the time.

14. Maintains the confidentiality of beneficiary and department information 100% of the time.

15. Promotes and contributes positively to intradepartmental and interdepartmental relationships.

16. Adheres to applicable dress codes as observed by supervision.

17. Adheres to applicable safety policies and procedures 100% of the time.

18. Maintains proper attendance and punctuality to ensure that such organizations are operated in an efficient and cost-effective manner.

19. Maintains proper attendance and reports to work on time in accordance with applicable policies.

20. Provides adequate notice to supervisory personnel prior to absence or tardiness in accordance with applicable policies.

21. Participates in meeting the goals and objectives of the department to ensure that the department contributes to the attainment of such organizations’ goals and objectives.

22. Promotes and contributes positively to the teamwork of the department by volunteering to assist co-workers, contributing ideas and problem solving with coworkers.

23. Participates in planning and implementing change and maintaining and improving productivity through attendance and participation in staff meetings, task forces, projects and discussions.

24. Performs other duties related to Peak Health as assigned by the Chief Legal Officer, Peak Health President, and/or other members of Peak Health leadership.

PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. General office work

SKILLS AND ABILITIES:

1. Excellent organizational and interpersonal skills

2. Excellent verbal and written communication skills

3. Ability to manage multiple tasks at one time

4. Ability to work under stress and with short deadlines

5. Ability to solve problems in a timely and practical fashion

6. Knowledge of laws and regulations applicable to health insurers, payers, and managed care company.

7. Knowledge of litigation process and procedures

8. Knowledge of the general operations of non-profit and for-profit corporations, limited liability companies, and joint ventures

9. Knowledge of laws and regulations applicable to hospitals and professional providers preferred

Additional Job Description:

Scheduled Weekly Hours:

40

Shift:

Exempt/Non-Exempt:

United States of America (Exempt)

Company:

SYSTEM West Virginia University Health System

Cost Center:

509 SYSTEM Legal Services

Address:

1085 Van Voorhis Rd

Morgantown

West Virginia

WVU Medicine is proud to be an Equal Opportunity employer. We value diversity among our workforce and invite applications from all qualified applicants regardless of race, ethnicity, culture, gender, sexual orientation, sexual identity, gender identity and expression, socioeconomic status, language, national origin, religious affiliation, spiritual practice, age, mental and physical ability/disability or Veteran status.