Sr. Director, Legal Counsel-Dispute Resolution and Government Programs

Company: Blue Shield of California
Location: Oakland
Posted on: July 30, 2022

Job Description:

Blue Shield of California's mission is to ensure all Californians have access to high-quality health care at a sustainably affordable price. We are transforming health care in a way that truly serves our nonprofit mission by lowering costs, improving quality, and enhancing the member and physician experience.
To fulfill our mission, we must ensure a diverse, equitable, and inclusive environment where all employees can be their authentic selves and fully contribute to meet the needs of the multifaceted communities we serve. Our comprehensive approach to diversity, equity, and inclusion combines a focus on our people, processes, and systems with a deep commitment to promoting social justice and health equity through our products, business practices, and presence as a corporate citizen.
Blue Shield has received awards and recognition for being a certified Great Place to Work, best place to work for LGBTQ equality, leading disability employer, one of the best companies for women to advance, Bay Area's top companies in volunteering & giving, and one of the world's most ethical companies. Here at Blue Shield of California, we are striving to make a positive change across our industry and the communities we live in - join us!
Your RoleThe Associate General Counsel, Dispute Resolution and Government Programs ("AGC") will provide strategic advice and counsel on a broad range of health care disputes and issues, with a particular focus on health care litigation, provider arbitration, regulatory enforcement actions, subpoenas, and investigations related to government programs (Medicare and Medi-Cal). The ACG will be the primary litigation attorney supporting Blue Shield of California's and Blue Shield of California Promise Health Plan's government programs lines of business, but will also manage commercial disputes. The AGC will report to the Vice President, Deputy General Counsel, Litigation. The Law Department partners with the company's business leaders to embrace legal and ethical behavior in the achievement of the company's mission. The Litigation Group is highly regarded within the company and respected by management. It is comprised of top tier, analytical, ethical, collaborative and intelligent attorneys, paralegals, litigation specialists, fraud investigators, and administrative support staff. The AGC must comfortably adapt to change, lead with influence, demonstrate strong business acumen, master new responsibilities, effectively advise business clients in a dynamic business and legal environment, and possess a strong drive for excellence. This position will be hybrid within California.
Your WorkIn this role, you will:

• In consultation with appropriate Law Department leadership, retain, oversee, and manage the work of outside counsel and ensure adherence to outside counsel budget
• Recommend operational plans and strategies that directly impact the achievement of overall results for multiple departments and company-wide results, profitability, and/or public image of the organization
• Under the direction of the Vice President, Deputy General Counsel, coordinate all litigation and investigation-related legal services required by Blue Shield of California Promise Health Plan (the Company's Medi-Cal affiliate) and Blue Shield of California's Medicare business as an integral member of the leadership teams
• In consultation with Law Department leaders and the SVP/GC, establish legal policy and standards for the enterprise, and for the business and functional units served by the AGC
• Manage the paralegal assigned to government programs litigation, arbitration, subpoenas, and regulatory enforcement matters. Work collaboratively with other attorneys, paralegals and litigation specialists specializing in commercial disputes. Provide guidance and training to Blue Shield of California's highly capable and valued legal support professionals
• Defend Blue Shield of California Promise Health Plan and Blue Shield of California against litigation, arbitrations, investigations, subpoena response, and regulatory enforcement matters, in some cases directly, and in others, by supervising the work of outside legal counsel
• Pursue litigation and recovery
• Engage with government agencies in connection with subpoenas, enforcement actions, and investigatory demands. Partner with internal clients and paralegals to respond to discovery requests and investigatory demands.
• Provide timely, actionable advice and counsel to internal clients, enabling them to achieve their goals within a prudent range of legal risk, offering particular expertise in risks associated with government programs (Medicare, Medi-Cal)
• Other duties, as assigned
  Your Knowledge and Experience
  • Juris doctorate degree required; superior academic credentials from a top-tier law school strongly preferred
  • Must have at least 10 years of experience providing legal advice on relevant areas of the law (e.g., corporate, privacy, health care regulatory, litigation, contracts, et al) at a top law firm or in-house corporate law department.
  • Minimum of 8 years' litigation experience, at least 5 of which include recent experience defending health plans, health insurers or HMOs in litigation, arbitration, government investigations, subpoena response, and other formal or informal disputes. Combination of law firm and in-house experience preferred
  • Active member of California State Bar
  • Possess strong knowledge and recent experience, providing actionable legal advice to business clients related to the Knox-Keene Act, False Claims Act, Stark laws, Medicare Advantage, Medicare Supplement, and Medi-Cal
  • Demonstrated experience with contracted and non-contracted provider payment disputes
  • Self-motivated, enthusiastic, ethical, collaborative, and hard-working. A successful candidate will have a "roll up your sleeves" style and ability to partner and effectively communicate with employees at all levels of the organization
  • Requires strong written and oral communication skills, analytical skills, intellectual curiosity, interest in diving into the facts, and ability to meaningfully communicate with business clients at all levels of the organization regarding complex legal matters
    Our Values
    • Honest. We hold ourselves to the highest ethical and integrity standards. We build trust by doing what we say we're going to do and by acknowledging and correcting where we fall short
    • Human. We strive to be our authentic selves, listening and communicating effectively, and showing empathy towards others by walking in their shoes
    • Courageous. We stand up for what we believe in and are committed to the hard work necessary to achieve our ambitious goals

Keywords: Blue Shield of California, Oakland , Sr. Director, Legal Counsel-Dispute Resolution and Government Programs, Legal , Oakland, California