Legal Counsel Senior - Medicaid

Elevance Health•Atlanta, OH

3d•Hybrid

About The Position

The Legal Counsel Senior is responsible for completing a variety of routine and non-routine Medicaid legal assignments and intermediate level projects independently and using professional legal concepts and principles in accordance with company and departmental objectives to solve challenging, or legal issues in practical ways. Works autonomously with regular collaboration and reporting to management. At this level the associate has developed a specific technical depth and/or breadth of organizational and industry legal issues. This role requires associates to be in-office 3 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office. Candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

Requirements

Requires a JD, current license to practice law, and a minimum of 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.

Nice To Haves

Prior litigation, administrative hearing, or administrative law experience, with demonstrated ability to develop hearing strategy, prepare witnesses and evidence, manage outside counsel or internal stakeholders, and support or lead Medicaid State Fair Hearing proceedings across multiple jurisdictions preferred.
Experience with Medicaid managed care programs preferred.
Knowledge of federal Medicaid managed care regulations and familiarity with State Medicaid agency contracts preferred.
Experience advising health plans, managed care organizations, Medicaid agencies, providers, or healthcare entities on regulatory, litigation, administrative, or compliance matters preferred.
Experience managing high-volume, multi-jurisdictional matters or legal processes across multiple states or markets preferred.
Experience managing outside counsel, paralegals, hearing representatives, or cross-functional project teams preferred.
Strong ability to identify legal and operational risk trends, support remediation, and communicate effectively with senior leaders, regulators, hearing officers, clinicians, compliance teams, and operational stakeholders preferred.
Experience developing enterprise policies, procedures, playbooks, templates, training, or governance processes preferred.
Strong written and verbal advocacy skills, including the ability to explain complex legal, clinical, and operational issues clearly to hearing officers, regulators, business partners, and senior leaders preferred.
Ability to interpret complex healthcare regulations in a practical, business-oriented manner preferred.

Responsibilities

Leads legal strategy and support for Medicaid State Fair Hearing matters across all Medicaid markets.
Advises internal business partners on federal and state Medicaid hearing requirements, manages hearing preparation and representation, develops enterprise standards and best practices, supports risk mitigation and remediation, and partners with market, clinical, compliance, regulatory, and operations teams to ensure timely, consistent, and legally sound handling of member hearing matters.
Coordinates with and oversees outside counsel to ensure appropriate staffing, preparation, and support of all Medicaid State Fair Hearings.
Oversees development of quarterly Medicaid State Fair Hearing reporting, interprets report results, identifies legal and operational trends, and independently drives recommended actions to reduce risk, improve processes, and reduce avoidable hearing volume.
Works with more experienced attorneys to represent the organization in legal duties associated with serving as legal counsel for one or more Medicaid markets.
May research legal principles and precedents, consult with outside counsel, draft and execute legal documents, gather relevant case related information using multiple sources and methods.
Contributes to overall results of an SBU or CEE unit and/or department.
Serves as a strategic partner with assigned clients.
Provides legal solutions to a wide range of difficult or new problems.
Develops recommendations and solutions that are thorough, practical and consistent with organizational objectives.
May support the development of other attorneys and paralegals by providing guidance on technical and tactical procedures for lower level attorneys.
Assesses and mitigates risk for familiar situations.
Reports to management any identified business exposure and associated risks as well as mitigation techniques being utilized.