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Director of Legal Affairs, Fairfield, CA


Organization: Partnership HealthPlan of California
Category: Director
Location: Fairfield, CA
Date Job Posted: November 4, 2021
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Director of Legal Affairs

Job Locations US-CA-Fairfield
Job ID 2021-2018
FLSA Status Exempt

Overview

Provides advice and counsel to operational departments. As requested, coordinates certain outside legal counsel and oversees outside counsel contracts.

Responsibilities

ESSENTIAL DUTIES AND RESPONSIBILITIES

  • Overseeing legal research and ongoing review and analysis of relevant state and federal statutes and regulations, contractual provisions, and waivers with which the HealthPlan must comply, with duties including but not limited to:
  • Stay abreast of changes in contractual provisions or regulations and communicate those changes to relevant staff within the organization.
  • Assess organizational impact from enacted and potential legislation to make recommendations on compliance. Track regulatory and contractual requirements related to the HealthPlan’s business functions and work with department staff to translate and integrate requirements into daily HealthPlan operations.
  • Serve as primary contact with outside legal counsel; approve outside counsel, if needed.
  • Review and coordinate HealthPlan’s response to subpoenas and public records requests.
  • Advise executive team regarding Brown Act inquiries and requirements.
  • Perform legal review and assessments of vendor contracts for compliance with Federal and State Privacy laws and regulations. Advise leadership on management of business associate agreements, when requested.
  • Advise and participate in review of HealthPlan’s delegation contracts.
  • Participate in the review of the contracts with regulatory agencies and other related documents, as needed
  • Supervise legal affairs team
  • Participant in annual review of HealthPlan Compliance and Privacy policies and procedures.
  • As requested, provide department Directors with input regarding legal compliance.
  • Advise Regulatory Affairs and Compliance (RAC) unit regarding internal investigations related to Health Insurance Portability and Accountability Act (HIPAA) and Fraud, Waste and Abuse (FWA).
  • Participate in completing the annual compliance risk assessment and/or Security Risk Assessment.
  • Maintain educational requirements for bar license. Maintain membership in American Health Lawyers Association or equivalent organization.
  • All other duties as assigned.

Qualifications

Education and Experience

Bachelor’s degree required. Graduate of an ABA accredited law school; ten (10) years of experience in research and analysis of legal, statutory, and regulatory information and authority, especially with respect to health law; five (5) years of management experience in the healthcare field (managed care experience preferred); specialized knowledge in State programs, Medi-Cal (Medicaid), Title 22, and Knox Keene, preferred; or equivalent combination of education and experience. CHC, CHPC, CIPP, HCISPP, CIPM certification or preferred.

Special Skills, Licenses and Certifications

California State Bar License. Ability to conduct legal research utilizing online tools such as Westlaw or LexisNexis. Highly proficient in applicable business software applications including PC usage, Microsoft Word, PowerPoint, Excel, Adobe Acrobat, typing speed of 30 wpm. Valid California driver’s license and proof of current automobile insurance compliant with PHC policy are required to operate a vehicle and travel for company business.

Performance Based Competencies

Excellent oral and written communication skills. Ability to plan, organize, manage, and monitor work projects. Strong organizational skills with ability to prioritize assignments. Must work well under pressure with frequent interruptions and shifting priorities. Ability to communicate concepts clearly and concisely. Ability to exercise independent judgment. Diplomacy and tact in handling sensitive information regarding personnel matters, as required. Ability to interact with executives, delegates, and vendors effectively. Must be able to handle multiple tasks and meet deadlines.

Work Environment And Physical Demands

Ability to use a computer keyboard and other business machines. More than 50% of work time is spent in front of a computer monitor. When required, ability to move, carry, or lift objects of varying size, weighing up to 35 lbs.

All HealthPlan employees are expected to:

  • Provide the highest possible level of service to clients;
  • Promote teamwork and cooperative effort among employees;
  • Maintain safe practices; and
  • Abide by the HealthPlan’s policies and procedures as they may from time to time be updated.

IMPORTANT DISCLAIMER NOTICE

The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.

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