General Counsel/Chief Compliance Officer
About The Position
Trillium Health Resources is a Tailored Plan and Managed Care Organization (MCO) serving 46 counties across North Carolina. We manage services for individuals with serious mental health needs, substance use disorders, traumatic brain injuries, and intellectual/development (IDD) disabilities. Our mission is to help individuals and families build strong foundations for healthy, fulfilling lives. Trillium believes that empowering others begins with supporting our team. We offer our employees a collaborative, mission-driven work environment, competitive benefits and work-from-home options for most positions, and opportunities for professional growth in a diverse inclusive culture. Every day, our work changes lives – from children thriving through early intervention and school-based therapies, to adults with severe mental illness living independently and contributing to their communities. If you are looking for a unique opportunity to make a tangible impact on the lives of others, apply today! Trillium Health Resources has a career opening for a General Counsel/Chief Compliance Officer to join our team! The General Counsel serves as the chief legal officer for Trillium Health Resources (Trillium) and is a member of the Executive Team. This position provides comprehensive legal and compliance oversight of the organization and is responsible for the research, review, evaluation and analysis of Federal and State laws, rules and regulations pertaining to operations, with a particular emphasis on Medicaid managed care for BH and I/DD populations. Other areas of responsibility include: (1) Appeals of agency actions by providers and members; (2) Providing legal oversight over all contracting with state and local agencies, providers, vendors and other entities or individuals; (3) Overseeing and directing all litigation or other legal disputes involving the organization; (4) Reviewing and revising policies, procedures, forms, templates and correspondence and monitoring Trillium compliance with the same; (5) Responding to inquiries from staff concerning legal issues and providing advice and counsel regarding disputes with enrollees, providers, vendors or other stakeholders that may lead to litigation; (6) Public policy, governmental and legislative affairs; (7) internal compliance monitoring; (8) vendor integration and management; and (9) commercial contract management.
Requirements
- Juris Doctor (JD) from an ABA accredited law school.
- Minimum seven (7) years of progressively responsible legal experience in healthcare, managed care, and/or federal or state government representing a health plan or provider, including two (2) years supervisory experience.
- Licensed as an attorney in good standing in North Carolina.
- Must have a valid driver’s license.
- Must reside within North Carolina.
- Must be able to travel within catchment as required.
Nice To Haves
- Specialization in Medicaid, managed care, behavioral health, and/or administrative law.
Responsibilities
- Advise and assist staff with respect to reconsideration reviews, appeals, complaints, grievances, incidents, and inquiries/ investigations/audits conducted by regulatory authorities
- Develop and review contracts and agreements with state agencies, counties, providers, vendors, stakeholders or other entities and individuals
- Supervise the appeals unit, which facilitates all in-house reviews of appeals of agency decisions, including actions on authorization requests, actions with providers, and claims denial appeals
- Prepare employees for depositions and court appearances, respond to subpoenas directed to the organization and/or employees, and coordinate with judicial and legal authorities
- Oversee requests for documents under the NC Public Records law and assist as needed with responses to external requests for information from governmental or non-governmental organizations
- Oversee the management and monitoring of Trillium’s subcontracting of Tailored Plan core services to ensure adherence to Trillium’s Tailored Plan contract and related NC DHHS guidelines, laws, rules and regulations
Benefits
- Competitive benefits
- Work-from-home options for most positions
- Health Insurance with no premium for employee coverage
- Flexible Spending Accounts
- 24 days of Paid Time Off (PTO) plus 12 paid holidays in your first year
- NC Local Government Retirement Pension (defined-benefit plan)
- 401k with 5% employer match and immediate vesting
- Public Service Loan Forgiveness (PSLF) qualifying employer
- Quarterly stipend for remote work supplies
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What This Job Offers
Job Type
Full-time
Career Level
Manager
