Carelon Behavioral Health Legal Counsel Sr

Anticipated End Date:

Position Title:

Job Description:

Location: This role requires associates to be in-office 3 days per week fostering collaboration and connectivity while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work promoting a dynamic and adaptable workplace. Will consider candidates in additional locations other than those listed with a preference for Eastern and Central time zones.

Please note that per our policy on hybrid/virtual work candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment unless accommodation is granted as required by law

A proud member of the Elevance Health family of companies Carelon Behavioral Health uses our powerful combination of experience expertise dedication and compassion to see whats possible and whats better. Born out of one of the largest healthcare systems organization in the United States our rich history gives us a unique and valuable perspective on how to solve the most pressing healthcare challenges.

The Carelon Behavioral Health Legal Counsel Sr will help support the provider solutions team for insured self-funded and government business.

Primary duties include but are not limited to:

• Provide legal guidance on a range of health law regulatory contractual and operational matters.
• Work as a strategic partner with assigned clients and provide legal advice and guidance on business strategies or various corporate initiatives; and assist with evaluating legal risks; propose alternatives to minimize risk where applicable.
• Proactively assist provider contracting staff managing a behavioral health network with legal issues that arise during contract negotiations.
• Review proposed contract language changes; draft alternative language to protect the companys interests when needed.
• Support development and roll-out of new provider contract templates.
• Support provider disputes prior to litigation.
• Assist in early resolution of provider disputes to avoid litigation; interface with opposing counsel as needed.
• Assist with responding to regulatory inquiries or complaints.
• Support value-based contracting and negotiation of shared savings or risk arrangements.
• Utilize contract management software to facilitate tracking of custom provisions and documentation of required approvals.
• Review provider communications including manuals newsletters and material change notices to ensure compliance with legal and contractual requirements.

• Prepare settlement agreements letters of intent confidentiality agreements and other documents as needed.
• Reports on identified business exposure and associated risks to management as well as mitigation techniques being utilized.
• Works autonomously and manages work independently; Determines methods and procedures on new assignments and may coordinate legal projects with other legal colleagues or subject matter experts.

• Review provider communications including manuals newsletters and material change notices to ensure compliance with legal and contractual requirements.

Requirements

• Requires a JD; current license to practice law; 6 years of specific industry and/or technical legal experience post licensure; or any combination of education and experience which would provide an equivalent background.

Ideal Candidate has:

• Health Insurance Law: An understanding of the principles definitions and nuances within health insurance law.
• Knowledge of state laws impacting third party administrators.
• Federal Regulations: Knowledge of federal laws that regulate health insurance companies including MHPAEA ERISA ACA and other federal statutes impacting health insurance.
• Compliance: Understanding of regulatory compliance how to ensure adherence to laws regulations guidelines and specifications relevant to the health insurance business.
• Contract Law: Experience interpreting drafting and reviewing employer and member contracts and related materials.
• Experience with provider agreements.
• Working knowledge of state laws and regulations that apply to third party administrators or health plan operations.
• Excellent communication skills and problem-solving competencies.
• Commercial and Government business-Medicare or Medicaid experience is preferred.
• Experience working with providers is preferred.

For candidates working in person or virtually in the below locations the salary* range for this specific position is $160336-$240540

Location(s): Illinois Minnesota

In addition to your salary Elevance Health offers benefits such as a comprehensive benefits package incentive and recognition programs equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary offered for this specific position is based on a number of legitimate non-discriminatory factors set by the Company. The Company is fully committed to ensuring equal pay opportunities for equal work regardless of gender race or any other category protected by federal state and local pay equity laws.

* The salary range is the range Elevance Health in good faith believes is the range of possible compensation for this role at the time of this posting. This range may be modified in the future and actual compensation may vary from posting based on geographic location work experience education and/or skill level. Even within the range the actual compensation will vary depending on the above factors as well as market/business considerations. No amount is wages or compensation until such amount is earned vested and determinable under the terms and conditions of the applicable policies and plans. The amount and availability of any bonus commission benefits or any other form of compensation and benefits that are allocable to a particular employee remains in the Companys sole discretion unless and until paid and may be modified at the Companys sole discretion consistent with the law.

Job Level:

Workshift:

Job Family:

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes including those submitted to hiring managers are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy power our business outcomes and drive our shared success - for our consumers our associates our communities and our business.

We offer a range of market-competitive total rewards that include merit increases paid holidays Paid Time Off and incentive bonus programs (unless covered by a collective bargaining agreement) medical dental vision short and long term disability benefits 401(k) match stock purchase plan life insurance wellness programs and financial education resources to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager associates are required to work at an Elevance Health location at least once per week and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal state and local laws.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age citizenship status color creed disability ethnicity genetic information gender (including gender identity and gender expression) marital status national origin race religion sex sexual orientation veteran status or any other status or condition protected by applicable federal state or local laws. Applicants who require accommodation to participate in the job application process may contact for assistance. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal state and local laws including but not limited to the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 Florida Agency for Health Care Administration.

NOTE: Workday keeps job postings active through 11:59:59 PM on the day before the listed end date. Example: If the end date is 3/13 the posting will automatically come down on 3/12 at 11:59:59 other words the job is posted until 3/13 not through 3/13.