Overview

Description

In this role, the Assistant General Counsel, Clinical Operations will advise Humana business and clinical leadership on legal matters arising in connection with the delivery of clinical services and operations of Humana’s care delivery, home health, telehealth, and the intersection of technology and privacy with clinical operations.

Responsibilities

The Assistant General Counsel, Clinical Operations will apply provider-based expertise into the critical thinking essential to propel Humana’s integrated care delivery model and to deliver the best consumer experience as a health company. This role serves as the primary resource for business and clinical leaders across the enterprise on legal matters relating to the delivery of healthcare services and clinical operations.

The Assistant General Counsel, Clinical Operations works collaboratively with business and clinical leaders across the enterprise and all lines of business. This role reports to the Senior Vice President and Deputy General Counsel and requires the ability to interact with senior leaders across the enterprise, as well as the ability to recognize systemic and other significant matters to be addressed with the Senior Vice President and Deputy General Counsel. This role also requires the ability to effectively lead, manage, and coordinate with attorneys, outside counsel, paralegals, and administrative staff to achieve positive results.

This will be located in Boston, MA, Washington, D.C., Louisville, KY, or Miramar, FL., with Boston or Washington being preferred.
 

Key Responsibilities

The Assistant General Counsel (AGC) will be responsible for: 

–Providing proactive guidance and advice on all legal matters stemming from, and in support of, Humana’s home health and clinical office operations.  This will include, but not be restricted to:

  • Credentialing of new physicians
  • Drafting and reviewing employment agreements
  • Investigating and responding to malpractice claims and customer complaints
  • Licensure of healthcare professionals and new clinical offices

–Advising on Medicare laws, CMS regulations, and other health care fraud and abuse laws

–Supporting mergers, acquisitions, and other corporate actions related to clinical or home health service offerings

–Providing guidance to Humana leadership on regulatory compliance, legislative changes, government audits, and business transactions

–Render opinions pertaining to privacy, intellectual property, and other legal matters flowing out of the information technology and analytics functions

–Building the Legal team and developing multiple junior attorneys.  Coaching and mentoring associates with a goal of developing and retaining talent. 
 

               

Key Candidate Qualifications

The successful candidate will have a proven track record of collaborative and creative problem-solving, and thought leadership on health policy. He/she will have extensive and relevant expertise and experience specific to clinical operations (including private practice in national law firm and senior-level in-house counsel roles in a large physician practice group, hospital system, or other healthcare delivery setting).  This person will also possess a Juris Doctor degree, with admission to practice law in the state of Massachusetts, D.C., Kentucky, Florida or ability to waive in.

In addition to the above, the following professional qualifications and personal attributes will be ideal:

–Proven track record of delivering results with minimal outside counsel assistance

–Leadership and management to influence behavior in a constructive manner

–Ability to engage and collaborate effectively on cross-functional teams 

–Ability to think tactically and strategically

–Expertise in the following functional/technical areas:

  • Clinical governance and quality assurance structures such as credentialing and peer review
  • Professional and facility licensure requirements
  • Corporate practice of medicine and options for clinical practice expansion
  • Creative arrangements with management services organizations and joint venture partners
  • Population health management and value-based payment systems
  • Evaluation and resolution of medical, nursing, and other state regulatory board inquiries
  • Innovative modalities of care such as telehealth, business acumen to solve and anticipate compliance and other risks
  • The application of technology and privacy consents to cutting edge digital healthcare and data analytics.  

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