Smoky Mountain Center, a public managed care organization based in Asheville, is seeking a staff attorney.
GENERAL STATEMENT OF JOB: The Staff Attorney is responsible for assisting the General Counsel/ CCO with research, review, evaluation and analysis of Federal and State laws, rules and regulations pertaining to all aspects of the organization. Under the supervision of the General Counsel/ CCO, other areas of responsibility include: (1) Handling reconsiderations, appeals and matters in litigation, including but not limited to appeals filed by providers at the NC Office of Administrative Hearings and in other venues; (2) Responding to inquiries from staff concerning Smoky Mountain legal issues; (3) Reviewing and revising policies, forms, templates and correspondence; and (4) Providing advice and counsel regarding disputes with providers, vendors or other stakeholders that may lead to litigation.
ESSENTIAL JOB FUNCTIONS: Litigation and Litigation Risk Management
Provides guidance to the Contract Performance Team, Special Investigations Unit, Credentialing Team, Sanctions Committee, Smoky Reconsideration Panels and other Smoky staff regarding administrative actions and sanctions taken or contemplated against Network Providers.
Represents the organization in mediations, state administrative hearings, and other administrative or civil litigation matters, including but not limited to appeals filed by healthcare providers at OAH and in other venues.
Prepares and responds to pleadings, motions, discovery, and other legal documents pertaining to legal matters involving the organization.
Determines the merits of a case, develops case strategy, performs legal research and develops legal arguments in preparation for litigation.
Prepares employees for depositions and court appearances and coordinates with outside legal counsel retained by the organization.
Research, Consultation and Documentation Review
Provides legal advice and counsel to Smoky staff and committees as directed by the General Counsel/ CCO, with particular emphasis on human resource and network operation functions, including but not limited to provider monitoring, credentialing, and claims processing.
Studies, interprets and maintains working knowledge of federal and state laws, rules, regulations, court decisions, policy guidance, accreditation standards and other legal authorities affecting the organization.
Conducts legal research and prepares memorandums of law as requested by the General Counsel/ CCO.
Assists in developing staff trainings, education and written guidance on legal matters affecting the organization.
Assists as needed with correspondence and/or responses to requests for information, complaints, grievances, inquiries, investigations and/or audits conducted by regulatory agencies, including requests made under the NC Public Records law.
Provides assistance to the Contracting and Procurement Director related to drafting, revising and negotiating contracts and agreements with state and local agencies, network providers and other vendors. Assists as needed with review and analysis of contracts, agreements and proposals presented to the organization by outside vendors to determine legal sufficiency and identify potential liabilities
Assists in developing and/ reviewing policies, procedures, forms and templates to ensure compliance with applicable laws, rules and regulations and minimize potential risks and liabilities for the organization.
QUALIFICATIONS & CREDENTIALING REQUIREMENTS: JD from an ABA accredited law school. At least three to five years of progressively responsible professional legal experience, including health law experience, preferred.
Licensure: Licensed as an attorney in good standing in North Carolina.
PHYSICAL REQUIREMENTS: Close visual acuity to perform activities such as preparation and analysis of documents; viewing a computer terminal; and extensive reading. Physical activity in this position includes crouching, reaching, walking, talking, hearing and repetitive motion of hands, wrists and fingers. Sedentary work with lifting requirements up to 10 pounds, sitting for extended periods of time.
KNOWLEDGE OF JOB: This position should require little direct supervision. A high level of diplomacy and discretion is required to effectively negotiate and resolve issues with minimal assistance. This will require exceptional interpersonal skills, highly effective communication ability, and the ability to make prompt, well-reasoned decisions based upon relevant facts.
Problem solving, negotiation, arbitration and conflict resolution skills are essential. Ability to maintain effective working relationships and to work objectively and impartially with individuals representing various departments, issues or views. Working knowledge of administrative law and experience with the NC Office of Administrative Hearings strongly preferred.
Experience representing health plans, insurers, and/or health care providers and working knowledge of NC Medicaid program, Medicaid managed care programs and/or Medicare program preferred.
Experience interacting with NC Department of Health and Human Services, the Centers for Medicare and Medicaid Services and/or the Office of Inspector General preferred.
Ability to conduct administrative and civil litigation. Ability to interpret and apply constitutional provisions, statutes, administrative regulations, court decisions, and other precedents, and to analyze facts, evidence, and legal instruments. Ability to express conclusions and arguments clearly and logically in oral and written form.
Proficiency in Microsoft Office products (such as Word, Excel, Outlook, PowerPoint, etc). Must have valid NC driver’s license and be able to provide own transportation in conduct of work assignments; willingness to travel as needed. Must be able to use computers, copiers, scanners and other office equipment that will be used routinely.
Decision Making/Consequences of Error: Error could result in failure to meet statute or regulatory requirements that may have significant legal consequences for the organization.
Nature and Purpose of Public Contacts: Interpersonal contacts are a significant factor in the employee’s effective performance of job duties. The employee must be able to communicate effectively with employees, management, senior Coordinators, providers, and vendors. Contacts involve discussions of contracts, program and project development, systems design, implementation efforts, data disseminations, and specific program issues in current projects.
SALARY: Grade/Step is determined by qualification and experience of candidate. Position is full-time salary with comprehensive benefits. This position is exempt from overtime compensation.
DEADLINE FOR APPLICATION: Open until filled. Apply online at this address: http://www.jobs.net/jobs/smoky-mountain-center-widget/en-us/job/United-States/Staff-Attorney/JHL8675X76ZPXP629S7/