Assistant General Counsel – Health Plan Operations

🔥 1 hour ago

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Devoted Health

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2017

🏥 Healthcare

⚕️ Healthcare Insurance

🧘 Wellness

Healthcare • Healthcare Insurance • Wellness

Devoted Health is a healthcare company that offers Medicare Advantage plans designed to provide comprehensive health coverage with added benefits like dental, eyewear, gym memberships, and prescription drugs at competitive rates. The company emphasizes member support and service, ensuring that clients can easily navigate their benefits and access needed healthcare services. Devoted Health is committed to helping customers save money and enhance their health and wellness through a complete package of benefits and support.

📋 Description

• Support the claims process, advising on claims adjudication, payment integrity, appeals, and related legal and regulatory requirements. • Support the network development and management team and advise on provider contracting, provider relationships, credentialing, and related operational matters. • Work with compliance to ensure adherence to state regulatory requirements, and advise on compliance with state and federal health care laws and regulations. • Advise on delegation arrangements with third parties, including TPAs, PBMs, behavioral health vendors, and other delegated entities. • Collaborate cross-functionally with internal teams to support delegated entity oversight programs, including compliance monitoring, remediation, and regulatory reporting obligations. • Interpret new and evolving regulatory guidance and translate it into actionable recommendations for business and clinical teams. • Support regulatory exams, audits, and inquiries from state departments of insurance and other regulatory agencies. • Support the legally compliant implementation of clinical programs, quality initiatives, and utilization controls. • Work closely with cross-functional team members and business leaders to review legal issues and the implications of potential business decisions and initiatives.

🎯 Requirements

• Licensed to practice in at least one state, with eight to ten (8–10) years of experience, including a minimum of two to four (2–4) years of in-house experience. • Prior in-house experience at a health plan. • Knowledge of health care regulatory requirements applicable to health plan operations, including claims, provider contracting, delegation and delegated entity oversight, and state and federal health care laws and regulations. • Exercise strong business acumen and the ability to analyze legal issues from a business perspective. • Proven ability to follow through on complex issues, meet regulatory deadlines, proactively anticipate requirements, and build strong, collaborative relationships with regulators and internal business partners. • Outstanding interpersonal, organizational, and communication skills (effective speaking and written presentation), with the ability to work effectively across departmental lines. • Proactive, solutions-oriented mindset, with the ability to navigate ambiguity and scale legal processes in a growing organization. • Act with a high level of personal integrity, professionalism, intellectual curiosity, and willingness to grow. • Ability to manage several varied tasks and assignments efficiently and effectively to meet deadlines with a high sense of urgency. • Prior in-house experience for a Medicare Advantage plan will be considered an invaluable asset but is not required.

🏖️ Benefits

• Employer sponsored health, dental and vision plan with low or no premium • Generous paid time off • $100 monthly mobile or internet stipend • Stock options for all employees • Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles • Parental leave program • 401K program • And more....