Carelon Behavioral Health Legal Counsel Sr

Elevance Health•Atlanta, OH

20h•Hybrid

About The Position

Carelon Behavioral Health, a proud member of the Elevance Health family of companies, is seeking a Legal Counsel Sr to support the provider solutions team for insured, self-funded, and government business. This role involves providing legal guidance on health law, regulatory, contractual, and operational matters. The Legal Counsel Sr will act as a strategic partner to assigned clients, offering advice on business strategies and corporate initiatives, and assisting in evaluating and minimizing legal risks. A key responsibility includes proactively supporting provider contracting staff in managing a behavioral health network, addressing legal issues during contract negotiations, reviewing and drafting contract language, and supporting the development of new provider contract templates. The role also involves supporting provider disputes prior to litigation, assisting in early resolution to avoid legal action, and interfacing with opposing counsel when necessary. Additionally, the Legal Counsel Sr will help respond to regulatory inquiries and complaints, support value-based contracting and negotiation of shared savings or risk arrangements, and utilize contract management software. The position requires reviewing provider communications for legal and contractual compliance, preparing various legal documents, and reporting business exposures and risks to management. The role demands autonomous work, independent management of tasks, and the determination of methods and procedures for new assignments, with the potential to coordinate legal projects with colleagues or subject matter experts.

Requirements

Requires a JD; current license to practice law; 6 years of specific industry and/or technical legal experience post licensure; or any combination of education and experience, which would provide an equivalent background.
Health Insurance Law: An understanding of the principles, definitions, and nuances within health insurance law.
Knowledge of state laws impacting third party administrators.
Federal Regulations: Knowledge of federal laws that regulate health insurance companies, including MHPAEA, ERISA, ACA, and other federal statutes impacting health insurance.
Compliance: Understanding of regulatory compliance, how to ensure adherence to laws, regulations, guidelines, and specifications relevant to the health insurance business.
Contract Law: Experience interpreting, drafting and reviewing employer and member contracts and related materials.
Experience with provider agreements.
Working knowledge of state laws and regulations that apply to third party administrators or health plan operations.
Excellent communication skills and problem-solving competencies.

Nice To Haves

Commercial and Government business-Medicare or Medicaid experience is preferred.
Experience working with providers is preferred.

Responsibilities

Provide legal guidance on a range of health law, regulatory, contractual and operational matters.
Work as a strategic partner with assigned clients and provide legal advice and guidance on business strategies or various corporate initiatives; and assist with evaluating legal risks; propose alternatives to minimize risk where applicable.
Proactively assist provider contracting staff managing a behavioral health network with legal issues that arise during contract negotiations.
Review proposed contract language changes; draft alternative language to protect the company's interests when needed.
Support development and roll-out of new provider contract templates.
Support provider disputes prior to litigation.
Assist in early resolution of provider disputes to avoid litigation; interface with opposing counsel as needed.
Assist with responding to regulatory inquiries or complaints.
Support value-based contracting and negotiation of shared savings or risk arrangements.
Utilize contract management software to facilitate tracking of custom provisions and documentation of required approvals.
Review provider communications, including manuals, newsletters, and material change notices, to ensure compliance with legal and contractual requirements.
Prepare settlement agreements, letters of intent, confidentiality agreements and other documents as needed.
Reports on identified business exposure and associated risks to management as well as mitigation techniques being utilized.
Works autonomously and manages work independently; Determines methods and procedures on new assignments and may coordinate legal projects with other legal colleagues or subject matter experts.