Essential Functions: Reporting to the Chief Legal Officer, the Vice President, General Counsel – Health Plan and Value-Based Care Operations, is a mission critical, General Counsel position dedicated to the oversight and delivery of legal services supporting BSWHs Health Plan and Value-Based Care operations on an enterprise-wide basis. BSWH The VP, General Counsel Health Plan and Value-Based Care Operations:
- Oversees and manages the following core legal functions of the enterprise: - Insurance Regulation and Coverage, including all aspects of state insurance regulation, licensure, insurance form filings, extraterritorial compliance, audits and investigations, and coverage disputes. - Governmental Programs and Health Insurance Exchange, including Medicare Advantage, managed Medicaid and Medicaid procurement processes, Medicare shared savings and bundled payments, Medicare Direct Contracting, state and federal government accounts, and audits and investigations regarding compliance with government program requirements. - Support for provider or member disputes - Health Plan Contracting, including delegation agreements, intercompany agreements, pharmacy benefits management, third-party administrator, utilization review, vendor contracts, and reinsurance and stop loss. - Commercial and Direct-To-Employer Contracting, including risk contracting arrangements. - Accountable Care Organization regulation and participation in risk arrangements with employers or governmental bodies - Clinically integrated networks - Counsel to the value-based care platform, including antitrust and data sharing and privacy in collaboration with the Regulatory Operations family. - Has core legal and subject matter expertise in one or more of the substantive areas of oversight. - Performs substantive legal work in his/her core areas of expertise while also overseeing and managing a team of attorneys and legal support staff. - Provides practical advice and counsel to the business as a general counsel. - Serves as a legal point person to business leaders and navigator to address legal issues impacting complex business problems or strategies. - Oversees substantive legal projects within the Health Plan and Value-Based Care Operations family, coordinating with and supervising the attorney team leaders within the family, with direct access and accountability to the Chief Legal Officer of BSWH. - Engages and effectively manages outside counsel as needed for strategic areas of legal support to ensure high value to BSWH. - Proactively stays abreast of legal developments impacting subject matters within the Health Plan and Value-Based Care Operations family and provides updates to the department and BSWH, as applicable. - Identifies and executes on process improvements to improve the effectiveness and efficiency of the delivery of legal services within the Health Plan and Value-Based Care Operations family and BSWH. - Develops and promotes a culture for high performing teams.
Organization of BSWH Legal Department: The Baylor Scott & White Health (BSWH) Legal Department provides comprehensive legal services across the BSWH enterprise. Legal services are organized and provided on an enterprise-wide basis by core areas of subject matter expertise organized by “family” and, within each family core “teams,” each led by an attorney leader and supported by other attorneys and legal support staff. The families and teams are organized as follows: - Health System Operations - Health Care Operations - Health Plan and Value-Based Care Operations - Regulatory Operations - Claims, Litigation and Risk Prevention - Legal, Risk and Compliance Operations
The Legal Department operates in collaboration and coordination with Risk Management, Compliance and Internal Audit. The Chief Risk Officer and Chief Compliance Officer report to the Chief Legal Officer.
Attorneys and legal support staff within each family report to the attorney leader of the family. The attorney leaders of the Health System Operations, Health Care Operations, and Health Plan and Value-Based Care Operations families report to the BSWH Chief Legal Officer. The attorney leaders of the Regulatory Operations, Claims, Litigation and Risk Prevention, and Legal, Risk and Compliance Operations families report to the BSWH Chief Risk Officer.
Preferred Candidate Profile: - Experience in a private law firm and/or in-house counsel for an integrated healthcare delivery system including the following core functions: hospitals, physician clinics, academic medicine (UME and GME), research, ambulatory sites, joint venture relationships (including physician/hospital joint ventures), accountable care organizations and clinically integrated networks, health plan (including Medicare Advantage and Medicaid), pharmacy and 340b, provider-based billing and reimbursement, digital health, and tax-exemption. - Proactive, collaborative executive. - Visible, approachable individual who is an effective communicator and educator - Strategic business partner dedicated to managing and reducing potential risk and exposure while furthering strategic objectives. - Leader and motivator of people and teams. - Servant leader who is passionate about the mission of BSWH and those we serve - Solution-oriented team player who has credibility and integrity, provides counsel and contributes broadly as a subject matter expert. - Capable of nurturing a culture that actively seeks input from compliance to further optimize BSWH’s day-to-day operations.
Requirements: - Bachelors degree and Juris Doctor required. - Candidates must have an outstanding record of achievement with at least ten years of experience in healthcare law with particular experience and subject matter expertise in one or more of the substantive legal areas included within Health Plan and Value-Based Care Operations family. - Law license in state where currently practicing. If not Texas, obtain license within reasonable period following hire (6-12 months)
Baylor Scott & White Health (BSWH) is the largest not-for-profit health care system in Texas and one of the largest in the United States. With a commitment to and a track record of innovation, collaboration, integrity and compassion for the patient, BSWH stands to be one of the nation’s exemplary health care organizations. Our mission is to serve all people by providing personalized health and wellness through exemplary care, education and research as a Christian ministry of healing. Joining our team is not just accepting a job, it’s accepting a calling!