Job Abstract

Community Health Choice, Inc. (Community) is a non-profit managed care organization (MCO), licensed by the Texas Department of Insurance. Through its network of more than 10,000 providers and 94 hospitals, Community serves over 400,000 Members with the following programs:

* Medicaid State of Texas Access Reform (STAR) program for low-income children and pregnant women

* Children’s Health Insurance Program (CHIP) for the children of low-income parents, which includes CHIP Perinatal benefits for unborn children of pregnant women who do not qualify for Medicaid STAR

* Health Insurance Marketplace Plans that offer individual health coverage that includes preventive care, emergency services, prescription drugs, and hospitalization available to all, regardless of pre-existing conditions.

* Community Health Choice (HMO D-SNP), a Medicare Advantage Dual Special Needs plan for people with both Medicare and Medicaid that combines Medicare Part A and Part B benefits, Medicare Part D prescription drug coverage, and Medicaid benefits with additional health benefits like dental, vision, transportation, and more.

Improving Members' experiences is at the heart of every Community position. We strive every day to make sure that our Members have access to the high-quality health care they need and deserve.

Community is accredited by URAC for its health plan operations. We offer care management programs for asthma, diabetes, and high-risk pregnancy. An affiliate of the Harris Health System (Harris Health), Community is financially self-sufficient and receives no financial support from Harris Health or from Harris County taxpayers.

ASSISTANT GENERAL COUNSEL

JOB SUMMARY:
The Assistant General Counsel I supports and reports to the Chief Legal Officer and provides legal advice on a wide variety of matters related to Community's Medicare, Medicaid and Marketplace programs and operations including contracting, quality, utilization management, network management, privacy and security, litigation, fraud, waste and abuse, and contractual and regulatory compliance. 

JOB SPECIFICATIONS AND CORE COMPETENCIES:
* Collaborate regularly with members of the legal team to help streamline work, legal operations and effective risk management.
* Manage day-to-day legal issues including vendor and provider contracting, privacy, litigation/disputes, compliance and regulatory matters.
* Ensure timely and effective management of legal requests.
* Work effectively within a Legal Operations infrastructure that is innovative, cost effective and scalable as the organization and team grow.
* Assist operational leadership and managers in managing vendor selection and performance and resolving disputes.
* Assist the Chief Legal Officer as needed with Board and other governance issues and special projects.
* Ensure effective collaboration with stakeholders including within Community Health Choice and externally, including Harris Health.
* Maintain current knowledge, monitor changes, and provide research on Community's legal requirements including but not limited to licenses, certifications and accreditations as well as the requirements of the Texas Administrative Code, Texas Insurance Code, Health and Human Services Commission (HHSC), Texas Department of Insurance (TDI), Health and Human Services (HHS), Centers for Medicare and Medicaid Services (CMS), and other regulatory entities.
* Demonstrate Harris Health and Community Health Choice values, including trust, integrity, mutual respect, diversity, responsiveness and caring service.
* Actively contribute to achievement of departmental goals, as identified in Department's annual business plan, including specific departmental process improvement plans.
* Collaborate regularly with members of the legal team to help streamline work, legal operations and effective risk management.
*  Manage day-to-day legal issues including vendor and provider contracting, privacy, litigation/disputes, compliance and regulatory matters.
*  Ensure timely and effective management of legal requests.
* Work effectively within a Legal Operations infrastructure that is innovative, cost effective and scalable as the organization and team grow.
* Assist operational leadership and managers in managing vendor selection and performance and resolving disputes.
* Assist the Chief Legal Officer as needed with Board and other governance issues and special projects.
* Ensure effective collaboration with stakeholders including within Community Health Choice and externally, including Harris Health.
* Maintain current knowledge, monitor changes, and provide research on Community¿s legal requirements including but not limited to licenses, certifications and accreditations as well as the requirements of the Texas Administrative Code, Texas Insurance Code, Health and Human Services Commission (HHSC), Texas Department of Insurance (TDI), Health and Human Services (HHS), Centers for Medicare and Medicaid Services (CMS), and other regulatory entities.
* Demonstrate Harris Health and Community Health Choice values, including trust, integrity, mutual respect, diversity, responsiveness and caring service.
* Actively contribute to achievement of departmental goals, as identified in Department¿s annual business plan, including specific departmental process improvement plans.

MINIMUM QUALIFICATIONS:
Education/Specialized Training/Licensure: Doctor of Jurisprudence/JD degree; license to practice law in State of Texas required.  
Work Experience (Years and Area): Licensed 3-7 years with a minimum of 3 years managed care experience in a health plan or law firm required.
Knowledge of Medicare, Medicaid, CHIP, Marketplace, and other government managed care programs preferred.  Experience with provider affiliated health system health plans a plus.
Management Experience (Years and Area): None Required
Software Proficiencies: Microsoft Office required. Experience with contract management systems and legal operating systems including e-billing, matter management and CLM tools preferred.
Other: Knowledge of a combination of health insurance and Medicaid, Medicare, Marketplace operations, regulations and compliance requirements. Familiarity with HIPAA privacy and security regulations. Experience supporting middle and upper management required.

Please click on the link below to apply for this position. A new window will open and direct you to apply at our corporate careers page. We look forward to hearing from you!