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Senior Counsel - Healthcare and Corporate in Pasadena, California at Imperial Management Administrators Services Inc

NewSalary: $200000 - $260000Job Function: Professional Services
Imperial Management Administrators Services Inc
Pasadena, California, 91106-2513, United States
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Job Description

Imperial Health
Pasadena, California

Position Overview

Imperial Health is seeking an experienced, practical and business-oriented attorney to join the organization as Corporate Counsel – Healthcare.

This is a broad, hands-on in-house legal role supporting Imperial's health plans and affiliated healthcare businesses. The attorney will work closely with executive leadership, Compliance, Human Resources, Finance, Operations, Claims, Network/Provider Relations and other business teams and will coordinate with Imperial's outside counsel in California and other states.

The successful candidate will be comfortable independently managing a wide variety of legal matters—from contracts and provider disputes to regulatory matters, employment issues, settlements, arbitrations and litigation—while recognizing when specialized outside counsel should be engaged.

This position is intended for an attorney who wants to own matters rather than simply refer them to outside counsel.

Key Responsibilities

  • Serve as a principal internal legal resource for Imperial's health plans and affiliated healthcare businesses on day-to-day legal and business matters.
  • Manage litigation, arbitration and pre-litigation disputes, including provider and reimbursement disputes, contract disputes, employment matters and other commercial claims.
  • Evaluate claims and disputes, develop strategy, coordinate internal factual investigations and document collection, supervise discovery, and work directly with outside litigation counsel.
  • Negotiate and resolve claims and settlements, including evaluating legal and financial exposure, developing settlement strategy, negotiating settlement terms and preparing or reviewing settlement and release agreements.
  • Manage outside counsel in California and other states, including selecting appropriate counsel, defining scope and strategy, reviewing work product, monitoring deadlines and controlling legal spend.
  • Draft, review and negotiate contracts, including provider agreements, Letters of Agreement (LOAs), vendor and services agreements, NDAs, BAAs, technology agreements, consulting agreements and other healthcare and commercial contracts.
  • Advise on provider contracting, reimbursement, claims-payment disputes, contract interpretation, network matters and related managed-care issues.
  • Partner closely with Compliance on regulatory inquiries, investigations, compliance issues, corrective actions, policies and procedures, and implementation of federal and state regulatory requirements.
  • Assist with matters involving CMS, DMHC, state Departments of Insurance and other federal and state regulators, coordinating with regulatory counsel where appropriate.
  • Support legal and regulatory matters associated with Imperial's operations and expansion into multiple states.
  • Partner with Human Resources on internal employment matters, including employee complaints, investigations, disciplinary matters, terminations, accommodations, employment agreements and threatened employment claims, with specialized employment counsel engaged when appropriate.
  • Support enterprise risk management, including identifying emerging legal exposures, evaluating potential liability, assisting with insurance-related matters and developing strategies to mitigate legal and operational risk.
  • Respond to or oversee responses to demand letters, subpoenas, regulatory inquiries, complaints and other formal legal communications.
  • Advise business teams on healthcare laws and regulations affecting health-plan and healthcare operations.
  • Assist with corporate governance and general corporate matters involving Imperial and its affiliated entities.
  • Develop practical processes for contract management, litigation and dispute tracking, legal holds, outside-counsel management and other Legal Department functions.
  • Provide senior management with clear, concise and practical assessments of legal risk and recommended courses of action.

    • Qualifications

  • Juris Doctor (J.D.) from an ABA-accredited law school.
  • Active member in good standing of the State Bar of California required.
    • Ideally 4-8 years of legal experience, with flexibility for particularly strong candidates.
  • Significant experience in healthcare law, managed care, health insurance, healthcare delivery or another highly regulated healthcare environment.
  • Prior in-house experience with a health plan, managed-care organization, healthcare company, medical group or health system strongly preferred.
  • Experience managing litigation, arbitration, disputes and settlements.
  • Strong contract drafting, review and negotiation experience.
  • Familiarity with provider agreements, LOAs, reimbursement arrangements and healthcare commercial contracts preferred.
  • Experience advising on employment and internal HR matters preferred.
  • Experience working with Compliance and advising on healthcare regulatory matters.
  • Knowledge of California healthcare law and regulation; experience with DMHC-regulated health plans particularly valuable.
  • Familiarity with Medicare Advantage, ACA/Exchange, Medicaid and/or commercial health-plan operations is highly desirable.
  • Experience managing outside counsel and legal budgets.
  • Ability to independently manage multiple complex matters while determining when specialized outside counsel is necessary.
  • Excellent judgment, negotiation, written communication and interpersonal skills.

    • The Attorney We Are Looking For

    The ideal candidate is a healthcare legal generalist with strong judgment and a willingness to be hands-on.

    This person should be comfortable receiving a new matter—whether a multimillion-dollar provider arbitration, regulatory inquiry, employment issue, proposed settlement, new provider LOA or commercial contract—and taking responsibility for determining the facts, identifying the legal and business risks, developing a recommended approach and driving the matter toward resolution.

    The attorney should be able to work effectively with executives and operating teams and translate complex legal issues into practical business recommendations.

    Just as importantly, the successful candidate will know when a matter requires specialized expertise and will be capable of selecting, instructing and managing outside counsel rather than simply turning the matter over to them.

    Job Location

    Pasadena, California, 91106-2513, United States

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