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§ Provide legal advice on a wide range of corporate matters
§ Provide day-to-day legal advice to ensure compliance with applicable laws, regulations, policy, Medicare, Medicaid, and accreditation standard
§ Represent CareSource in structuring and negotiating corporate transactions such as mergers, acquisitions, affiliations, and joint ventures
§ Draft and negotiate managed care contracts, including provider agreements, health network contracts, administrative services agreements, management agreements, vendor contracts, and reinsurance agreements; and work towards settlement in contract disputes towards settlement in contract disputes
§ Interface with regulators, including providing assistance in drafting
regulatory filings and communications for submission to regulators and attending meetings with regulators
§ Conduct legal research and render opinions on legal matters, such as fraud and abuse issues, privacy tax-exemption matters, legislation, and insurance regulations
§ Assist with and provide counsel to senior leadership in connection with both internal and external member appeals related to benefit coverage and internal and external provider appeals related to payment and audits (including representation of clients at administrative law judge proceedings)
§ Provide counsel on provider credentialing matters and represent CareSource at fair hearings
§ Give presentations to governing boards, management committees, and workgroups
§ Draft policies and procedures needed by CareSource to ensure that business operations are compliant with internal and external requirements
§ Advise CareSource as to regulatory reporting requirements (data bank, state licensing board, Office of Inspector General, Centers for Medicaid and Medicaid Services, Medicaid agency, and department of insurance, etc.
§ Prepare and review contracts and/or agreements between the company and outside organizations with heavy emphasis on IT related contracts
§ Provide legal advice on a wide range of topics related to health care law such as, HIPAA, regulatory compliance, Medicaid and Medicare issues and privacy rights
§ Interact with management team as well as with external representatives of the legal system, regulatory agencies, governmental entities and others
§ Perform due diligence on any new state operations, including qualifying each company in a new state for business operations
§ Speak on legal related topics on a quarterly basis
§ Perform any other job related instructions, as requested
§ Completion of a Juris Doctorate degree program from an accredited college/university is required
§ Minimum of five (5) years health care experience, in managed care and/or related health care industry is required
§ Experience with Medicaid/Medicare regulations is required
§ Advanced expertise in contract drafting, review, and negotiations
§ Advanced expertise in health care/managed care regulatory environment
§ Top analytic, research and organizational skills
§ Advanced Microsoft Office skills, including Word
§ Broad internet research skills
§ Excellent written and oral communications skills
§ Strong customer service and team orientation
§ Excellent time/project management and prioritization skills
§ Ability to excel in fluid, dynamic environment
§ Member in good standing of Ohio Bar, and admitted to one other state
§ Current, unrestricted license in state of practice is required
Internal Number: 19-0827
CareSource is nationally recognized for leading the industry in providing member-centric health care coverage. The company’s managed care business model was founded in 1989 and today CareSource is one of the nation’s largest Medicaid managed care plans. Headquartered in Dayton, Ohio, the company has built a legacy of providing quality health care coverage for Medicaid consumers. In addition to Medicaid coverage, CareSource has a diverse offering of insurance plans on the Health Insurance Marketplace. The company also offers Medicare Advantage plans that help consumers close the gap of coverage as they age. CareSource serves more than 1.8 million members across five states supported by a growing workforce of 4,300.