• Legal Specialist

    Job Locations US-NC-Gastonia
    Posted Date 3 weeks ago(3 weeks ago)
    Job ID
    # of Openings
  • Overview

    Excellent Benefits Package!!!

    Location: Gastonia, but may be negotiable for Hickory or Elkin for the right candidate

    Projected Hiring Range: $53,964 - $56,805

    Closing Date: Open Until Filled



    Primary Purpose of Position: To provide executive-level legal specialist services for the Legal Department aka Office of General Counsel (OGC) and its Chief Legal Officer/General Counsel (CLO/GC). Modeled from the NC DHHS Agency Legal Specialist II job description, this position entails professional legal work with specialization in a variety of legal/programmatic areas or functions, including but not limited to litigation, transactions, regulation, legislation, internal and external dispute resolution, Partners’ policies and procedures, and other aspects of North Carolina Medicaid and non-Medicaid managed behavioral healthcare. A key role will be to serve as a centralized coordinator and/or liaison of wide variety of legal processes handled by Partners via diverse procedures and business units, including provider, consumer and grievant/complainant disputes. Will also be primary communication contact for OGC and key coordinator of contracts and other transactional work for Partners initiated in other departments and requiring legal advice. Examples of other work include public records requests, participation in managerial conferences, assessment of the impact of proposed Federal or State legislation, explanation of proposed legislation to key Partners stakeholders including Regulatory Compliance Committees, research and compliance with the Administrative Procedures Act, representing Partners or assisting in administrative hearings where permitted, drafting or reviewing contracts, providing technical information or support to the OGC, creating and maintaining metrics for department, and helping with engagement of and billing by outside counsel. Work closely with Program Integrity Director, Waiver Contract Manager, Legal Specialist/Dispute Supervisor and their departments, also located in OGC. Position reports directly to Chief Legal Officer & General Counsel.


    NOTE: Representation of Partners in a court of law and other acts constituting the practice of law are the responsibilities of attorneys in or for the OGC. Position will cooperate with, assist and take significant responsibility for preparation of work by attorneys, but have no authority to act as legal counsel for Partners to extent deemed practice of law without first being properly licensed in good standing.


    Under licensed-attorney supervision where required, this position: 1) performs legal research, drafting, review, proofing and communications regarding contracts, litigation, subpoenas, hearing notices, pleadings, motions and related legal projects; 2) fields, routes and/or addresses (or ensures licensed attorney addresses) legal issues and questions from various Partners’ business units and staff; 3) interprets and assists in developing and maintaining relevant policies and procedures (P&Ps); 4) assists with preparation for and occasional participation in executive and board level meetings and other events involving the CLO/GC; 5) creates, maintains, analyzes and reports key OGC metrics; 6) ensures monitoring, prompt routing, payment and reimbursement of legal bills and expenses, including maintaining the OGC legal matters management and invoicing software and database; 7) is a key liaison and coordinator from OGC for all due processes of Partners, including but not limited to provider disputes, consumer disputes and grievances/complaints; and 8) other duties as needed consistent with an executive level professional legal specialist. Works with extremely sensitive and confidential information and records.



    Role and Responsibilities (percentages are approximations):

    70% Professional Legal Specialists Services – Disputes, Transactions, Litigation, Metrics/Goals and Communications:

    Under licensed-attorney supervision where required, provide complex legal specialist services. Examples include performing legal research, both formal from traditional legal research databases and from non-traditional resources such as State and Federal legislative and regulatory websites.

    • 25% Litigation & Dispute Coordination: With senior Legal Specialist and/or in-house attorney, assist in coordinating for OGC provider and consumer dispute due processes, even when process is primarily in other departments. This includes, but is not limited to:
      • provider disputes (Medicaid and non-Medicaid) via various Partners departments.   Responsible for coordinating timely internal Partners provider dispute/reconsideration process(es), including coordinating panel/committee hearings and completion/issuance of formal decision letters.   Ensuring proper assignment to and coordination of litigation by outside counsel.
      • consumer disputes (Medicaid and non-Medicaid) via utilization management (UM) department’s appeals unit. Monitoring, attending and where feasible handling select Office of Administrative Hearings (OAH) hearings and mediations.
      • Litigation: Coordinate and track all OGC litigation work, including provider disputes, consumer disputes, subpoenas, forensic evaluation and MDE orders, hearing notices, pleadings, motions. Work with outside and opposing counsels, OAH, Administrative Law Judges (ALJs) and other courts and judicial officials on diverse litigated matters.
    • 25% Transactions & Contracts: With senior Legal Specialist and/or in-house attorney, assist in obtaining, reviewing, interpreting, drafting, negotiating and ensuring execution of Partners contracts as primary liaison for OGC with the Partners business units originating any contracts requiring OGC input. Also drafting, reviewing, proofing and issuing communications with staff, outside counsel and others regarding contracts, transactions, real estate, and related legal projects.
    • 20% OGC Communications and Departmental Operations: With senior Legal Specialist and/or in-house attorney, serve as key link and source of guidance with other OGC Departments or business units, including Program Integrity and Waiver Contract Management, including Policies & Procedures and Regulatory Compliance functions. Create, maintain and communicate meaningful OGC metrics, data and dashboard. Serve as a primary face of OGC, fielding, routing and and/or addressing legal issues and questions from various Partners’ non-OGC business units and staff, and/or ensuring appropriate OGC staff does so and communicating that advice. Examples include working with Partners’ privacy and security officers and health information manager regarding releases of medical records and HIPAA/privacy issues; assisting Waiver Contracts Manager in State-related contracting issues, legislative/regulator inquiries, and liaising between Partners and the State; working with Internal Auditor, Finance and Program Integrity regarding financial audits, investigations, liens, levies, collections, insurance; assisting Quality Management and compliance officer with corporate and regulatory compliance matters; and Public Relations department’s public records requests. Review, interpret and assist in developing and maintaining relevant policies and procedures (P&Ps), including proofing for adoption by organization and approval by Board. Attend key law-related meetings, hearings and conferences, providing insights to and taking notes on behalf of CLO/GC. Able to gather, organize and marshal on demand relevant documents, information and evidence to support OGC work and obligations. units as appropriate to assure compliance with relevant grievance/complaint rules, regulations, policies, procedures and timelines.


    Required to consult CLO/GC for supervision on matters and in any instance that might be construed as the practice of law.



    20% Analytical and Organizational Services:

    Create, maintain, analyze and report key OGC metrics using various OGC-specific resources and interdepartmental support. Ensure engagement, monitoring, prompt routing, payment and reimbursement of legal bills and expenses, including maintaining the OGC legal matters management and invoicing software and database, CounselLink. Communicate with outside counsel regarding pending assigned cases and legal matters, billing guidelines and other needs. Help develop, implement, monitor and meet OGC departmental goals. Liaise with OGC staff (e.g., Grievances and Program Integrity) regarding data from and about their functions and outcomes.


    10% Other Duties and Projects as Assigned. Provides comprehensive administrative support to OGC and CLO/GC not covered by other staff. Coordinates and assists with highly visible functions and events, including substantive preparation of CLO/GC for Board, Executive Leadership, Operations Team, Management Team and other meetings; CFAC and provider forums, council and other meetings; legal trainings; various relevant committees and other events involving OGC functions or staff. Work with Executive Assistant to make room reservations, including IT needs; schedule and coordinate select conference calls, mediations, and hearings; maintain OGC legal files and records; and miscellaneous OGC operational matters. Back-up duties for OGC key functions and staff, including contract waiver management, grievance coordination and P&Ps.


    In all roles and responsibilities, assures confidentiality of information of a sensitive nature within the department and organization. Adheres to court, regulatory, Partners’ and other deadlines. Highly organized and digitally proficient, and able to multitask in fast-paced, detail-oriented environment. Maintains a thorough understanding of legal procedures and documents. Able and authorized to exercise good judgment in a variety of situations when communicating directly with persons within and outside Partners, including attorneys, judges, regulators, clinicians and others. Strong oral and written communication skills essential. Significant attention to accuracy. Excellent people skills.



    Knowledge, Skills and Abilities:

    • Considerable knowledge of the principles and practices of NC administrative law specifically and general knowledge of the laws, rules, and regulations applicable to LME/MCOs.
    • Ability to interpret laws, rules, regulations, and court decisions.
    • Ability to analyze facts, evidence, and legal documents.
    • Ability to express legal interpretations or conclusions of law clearly and logically in oral and written form.
    • Ability to maintain effective working relationships with the public and other persons contacted in the course of work.
    • Ability to anticipate and timely meet deadlines and projects.
    • Considerable knowledge of office practices, techniques, and technology.
    • Working knowledge of and the ability to understand legal documents, contractual language, legal processes and other complex or sophisticated topics and materials.
    • Excellent communication skills, both orally and in writing.
    • Detail oriented with excellent organizational skills, including ability to manage multiple schedules and tasks.
    • Proficiency in Word, Excel, Outlook and PowerPoint, including the ability to design reports and presentations for internal and external recipients; excellent typing skills.
    • Proficiency in CounselLink, LexisNexis and other law-related software and database resources.
    • Ability to manage and uphold integrity and confidentiality of sensitive data, internally and externally.
    • Ability to analyze, understand, and complete tasks related to state and federal rules, regulations and laws.
    • Ability to establish and maintain effective, positive working relationships with staff, other members of the organization and stakeholders.
    • Ability to analyze, interpret and recommend policy, rules, and procedural guidelines.
    • Ability to complete non-routine activities and tasks that require deviation from established procedures; must be able to choose the appropriate course of action and recognize the existence of and differences among situations; sound judgment and critical thinking.
    • Ability to plan and carry out the day-to-day work of the office based on priorities and knowledge of the departments; and
    • Ability to recognize sensitive or unusual situations that should be referred to another more appropriate staff member or to the supervisors.



    Education and Experience Required: Graduation from an accredited law school and at least two years of related professional legal or programmatic experience; or an equivalent combination of education and experience. Knowledge of and experience/proficiency with legal online legal research, matter management, billing and e-filing databases, resources and solutions and state and federal legislative and regulatory websites. Extensive knowledge and proficiency of Microsoft Office products (Word, Excel, Outlook, PowerPoint, etc.). Comfort and experience with electronic modes of communication, filing, record keeping and office management.


    Education and Experience Preferred: Experience in healthcare, especially public behavioral health, managed Medicaid, and healthcare payor systems and law. Knowledge of and experience/proficiency with LexisAdvance, CounselLink, WestLaw and e-OAH.


    Licensure/Certification Requirements:   None, including law license not required.



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