Associate General Counsel - Carelon Services

Associate General Counsel - Carelon Services

Associate General Counsel – Carelon Services

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. Alternate locations may be considered.

The Associate General Counsel - Carelon Services is responsible for providing legal advice and recommendations for initiatives and projects developed in response to clients overall objectives and needs. Focus of work is on large scale and/or high financial level projects with broad department and/or organizational impact and moderate level of risk. Works as a strategic partner and decision maker with more senior leaders and manages work independently.

How you will make an impact:

• Provide legal advice and counsel to business leadership on a wide range of health law, regulatory, contractual, and operational matters impacting Carelon Services businesses, including behavioral health, medical benefits utilization management, specialty care solutions, and care delivery companies.
• Collaborate with internal subject matter experts within Elevance's larger Legal, Compliance, and Public Affairs functions to provide comprehensive support and clear, consolidated legal advice to the Carelon Services businesses.
• Guide assigned business partners through enterprise-level governance reviews relating to Artificial Intelligence, Product Development, Technology Governance, and Regulatory Compliance.
• Work as a strategic partner with assigned clients and provide legal advice and guidance on business strategies or various corporate initiatives. Support the development of new products and services by evaluating legal and compliance risks and proposing mitigation strategies.
• Support value-based contracting and negotiation of shared savings or risk arrangements with strategic vendors and providers.
• Support the sales and growth function for assigned business units, including support for public and private procurements and RFP processes.
• Provide sound legal advice to the business on pre-litigation dispute management.
• Works autonomously and manages work independently. Escalates significant issues and risks, as well as proposed mitigation options, to business and legal leadership.
• May support the development of paralegals and legal specialists on the legal team.
• Light travel may be required.

Minimum Requirements:

Requires a JD, current license to practice law, and a minimum of 9 years of specific industry and/or technical legal experience post licensure; or any combination of education and experience, which would provide an equivalent background.

Preferred Skills, Capabilities and Experiences:

• Health Insurance Law: An understanding of the principles, definitions, and nuances within health insurance law preferred.
• Federal Regulations: Knowledge of federal laws that regulate health insurance companies, including the ACA, ERISA, the No Surprises Act, and other federal statutes impacting health insurance preferred.
• Expertise in legal and regulatory issues affecting utilization management activities, including prior authorization, medical necessity, clinical policies and guideline development, appeals, and external review organization appeals preferred.
• Compliance: Understanding of regulatory compliance, how to ensure adherence to laws, regulations, guidelines, and specifications relevant to the health insurance and health care services business preferred.
• Contract Law: Experience interpreting, drafting and reviewing health plan service contracts and managed care contracts. Experience with value-based care provider agreements and risk-bearing provider contracts preferred.
• Working knowledge of state laws and regulations that apply to health plan operations, TPAs, and utilization review agents preferred.
• Excellent communication skills and problem-solving competencies preferred.

For candidates working in person or virtually in the below location(s), the salary range for this specific position is $187,616 to $307,008.

Locations: Illinois; New York.