Legal Counsel - Provider Network Services

CVS Health•Hartford, CT

11d

About The Position

The Legal Counsel will support CVS Health’s Provider Network Services legal and business teams on a broad range of healthcare provider matters. The role covers complex provider contract negotiations for Commercial, Medicare, Medicaid, and Specialty lines of business; development and negotiation of value-based arrangements; pre-arbitration and litigation dispute resolution; credentialing, regulatory, and risk-management support; and legal support for participating and out-of-network providers in an assigned region. The attorney may also support Medical Management and Utilization Management. The ideal candidate will be located in the Mid-Atlantic or Northeast, with a hybrid or remote possibility. The attorney will advise business teams on regulatory exams, inquiries, and filings involving provider network matters; assess and mitigate legal risks related to provider relationships; support complex provider and health system contracting and risk-based arrangements; and work with internal and external counsel to resolve disputes before arbitration or litigation. The role also involves collaborating on sensitive internal and external communications, coordinating with Medicare and Medicaid counsel on federal and state legal research, serving as a subject-matter expert for assigned provider issues, and providing day-to-day risk-management support to regional provider network business clients. The position calls for proactive risk management, including identifying and tracking policies and practices that may create issues. The attorney will identify business and legal risks and develop solutions that balance legal considerations with business objectives. Success requires developing an understanding of operational systems and internal governance, maintaining positive client relationships, and demonstrating sound business judgment, strong communication, and interpersonal skills while managing multiple responsibilities.

Requirements

Actively practicing attorney with at least 5 years of demonstrated experience in a law firm and/or in-house setting.
Experience with healthcare or other regulatory matters.
Experience drafting and negotiating complex contracts and/or interacting with government regulators or agencies on healthcare matters.
Admission to practice law in at least one state and in good standing.
At least 3 years of experience with contracts and related issues.
Ability to travel up to 5%, including by plane.
Juris Doctor from an ABA-accredited institution.
Demonstrated business judgment and acumen.
Superior oral and written communication skills.
High level of interpersonal skills and ability to manage multiple responsibilities.

Nice To Haves

Experience with utilization management processes and regulations.

Responsibilities

Support Provider Network Services legal and business teams on healthcare provider matters.
Negotiate complex provider contracts across Commercial, Medicare, Medicaid, and Specialty lines of business.
Develop and negotiate value-based and risk-based arrangements.
Support pre-arbitration and litigation dispute resolution, including working with internal and external counsel to resolve provider disputes.
Provide credentialing, regulatory, and risk-management support for provider network matters.
Advise business teams on regulatory exams, inquiries, and filings involving provider networks.
Identify, prioritize, and help mitigate legal risks related to provider network relationships.
Collaborate on sensitive internal and external communications for stakeholders, including senior executives, regulators, lawmakers, advocates, and members.
Coordinate with Medicare and Medicaid counsel on federal and state legal research involving provider network services for government lines of business.
Serve as a subject-matter expert for assigned healthcare provider issues.
Provide day-to-day risk-management support to business clients responsible for provider networks in the assigned region.
Identify and track policies and practices that could lead to issues, and propose solutions that balance legal risks with business objectives.
Develop an understanding of operational systems and internal governance and maintain positive relationships with business clients.
Provide support to Medical Management and Utilization Management areas as needed.