Healthcare Counsel

TriWest Healthcare Alliance; Phoenix (AZ); Remote; USD 142,000 - 149,000; Full time

Benefits offered by this job

Medical, dental and vision coverage

Paid time off

401(k) Retirement Savings Plan

Job summary

TriWest Healthcare Alliance—a remote-position legal role—seeks a licensed attorney to support the Office of General Counsel by drafting, reviewing, and negotiating contracts with providers and organizations. The role focuses on healthcare regulatory matters, including Medicare, Medicaid, HIPAA, and related compliance issues.

You will advise medical management departments, manage disputes, and assist with regulatory research, policy development, and governance activities.

Qualifications

• Juris Doctor from an accredited law school.
• License to practice law in the state where services will be provided.
• U.S. Citizenship.
• Ability to obtain a favorable DoD background clearance.
• 2+ years of health care regulatory/transactional law experience.
• Excellent written and verbal communication skills.
• Experience advising managed care administrators, health plans, or providers.
• Familiarity with HIPAA, False Claims Act, Stark, Anti-Kickback and related laws.

Responsibilities

• Identifies and analyzes legal issues, conducts legal research, and ensures regulatory compliance.
• Investigates and provides general legal advice on TriWest’s health care operations.
• Reviews and negotiates provider agreements, business associate agreements, and contracts involving electronic health records or telehealth.
• Assists in providing legal advice to departments and committees on health law issues, including fraud and abuse, privacy and security.
• Drafts and reviews miscellaneous legal documents and correspondence.
• Researches current issues related to government health care programs and proposed regulations.
• Assists with development and monitoring of internal regulatory procedures.
• Reviews marketing materials and internal/external communications.
• Supports standing and ad hoc committees (peer review, quality, credentialing).
• Reviews and revises company policies to ensure compliance.
• Educates staff on legal requirements and informs leadership of legal ramifications.
• Performs other duties as assigned.

Skills

Legal research

Regulatory analysis

Contract negotiation

Written communication

Verbal communication

Healthcare compliance

Education

Juris Doctor (JD)

Bar license (US)

Tools

Microsoft Office

Job description

Profile

We offer remote work opportunities (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 & WY only). This is a remote position but will need to work regular business hours in Arizona Time. Our Department of Defense contract requires US citizenship and a favorably adjudicated DOD background investigation for this position. Veterans, Reservists, Guardsmen and military family members are encouraged to apply!

Job Summary

Supports the Office of General Counsel in advising and producing attorney work products that support TriWest’s healthcare-related departments including, but not limited to, Provider Services, Medical Management, Program Integrity, and Claims. The candidate will draft, review and participate in negotiating contracts with providers and other organizations with a goal of achieving acceptable risk levels. The candidate will also support legal and regulatory communications with providers and outside parties, participate in litigation management, and support legal and regulatory research needs. TriWest will prioritize candidates with experience with healthcare regulatory matters, including Medicare and Medicaid and conditions of participation in federal healthcare programs, anti-kickback laws, self-referral laws, HIPAA, and transactional matters for health care providers.

Education & Experience

Required:

• Juris Doctor degree from an accredited law school
• License to practice law in the state where legal services will be primarily provided
• U.S. Citizen
• Must be able to receive a favorable Interim and adjudicated final Department of Defense (DoD) background investigation
• 2+ years' health care regulatory/transaction 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 & regulations

Preferred

• 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

Key Responsibilities

• Identifies and analyzes legal issues (including conducting legal research, identifying new or emerging areas of risk, etc.), presents clear recommendations, and ensures legal compliance.
• Investigates, researches and provides general legal advice on a broad range of issues arising from TriWest’s health care operations.
• Reviews and negotiates documents and contracts as necessary including provider agreements, business associate agreements, transactions involving electronic health records, telehealth, and others as needs arise.
• Assists in providing legal advice to departments and committees throughout TriWest on health law issues, including fraud and abuse, privacy and security, and peer review privilege.
• Drafts and reviews other miscellaneous legal documents and correspondence.
• Researches current issues and developments related to government health care programs, health insurance, and impact of existing and proposed healthcare regulations.
• Performs legal research and prepares memoranda on other legal issues as assigned.
• 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 in connection with TriWest standing and ad hoc committees including, but not limited to, committees responsible for TriWest’s peer review, quality, and credentialing programs.
• Reviews and revises Company policies and procedures as required.
• Ensures that 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 of the legal ramifications of past and proposed company actions.
• Performs other duties as assigned.
• Regular and reliable attendance is required.

Competencies

Coaching / Training / Mentoring:

Actively foster 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 ability to focus on things which 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

Company Overview

Taking Care of Our Nation’s Heroes.

It’s Who We Are. It’s What We Do.

Do you have a passion for serving those who served?

Join the TriWest Healthcare Alliance Team! We’re On a Mission to Serve®!

Our job is to make sure that America’s heroes get connected to health care in the community.

At TriWest Healthcare Alliance, we’ve proudly been on that important mission since 1996.

Benefits

We’re more than just a health care company. We’re passionate about serving others! We believe in rewarding loyal, hard-working people who are willing to learn as they grow. TriWest Healthcare Alliance values teamwork. Join our team, fulfill your responsibilities, and you may also be considered for frequent pay raises, overtime opportunities to earn even more, recognition and reward programs, and much more. Of course, we also offer a comprehensive and progressive compensation and benefits package that includes:

• 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

TriWest job postings typically include a salary range, which can vary based on the specific role and location, but generally this position ranges from around $142,000 to $149,000 per year.

Equal Employment Opportunity

TriWest Healthcare Alliance is an equal employment opportunity employer. We are proud to have an inclusive work environment and know that a diverse team is a strength that will drive our success. To that end, TriWest strives to create an inclusive environment that supports diversity at every organizational level, and we highly encourage candidates from all backgrounds to apply. Applicants are considered for positions based on merit and without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability or any other consideration made unlawful by applicable federal, state, or local laws.