VP & Associate General Counsel, Clinical Operations

Vice President & Associate General Counsel – Clinical Operations

Become a part of our caring community and help us put health first. The Vice President & Associate General Counsel – Clinical Operations is a key member of the leadership team of the Law Department, responsible for advising the Company's care delivery lines of business under the CenterWell umbrella: CenterWell Primary Care, CenterWell Home Health, and Onehome. This role requires working independently at a law firm partner level in collaboration with other internal and external counsel. Success in the role requires the ability to thrive in a collaborative and dynamic environment and effectively partner across law, compliance, enterprise risk management, government affairs and business operations teams.

Location: Louisville, KY; Washington, D.C.; Chicago, IL

Key Responsibilities

• Lead the work of the Clinical Operations team in the Law Department (including lawyers, paralegals and other professionals across multiple offices), advising business colleagues on legal matters relating to the operations of the Company's senior-focused primary care and home care businesses.
• Provide guidance and advice with respect to a variety of issues related to the delivery of healthcare services, including:
• anti-kickback, Stark Law and other fraud, waste and abuse laws & regulations
• professional practice issues, including corporate practice of medicine, scope of practice laws, licensure, medical board disciplinary actions, and quality, patient safety, and peer review matters
• wide variety of contracting matters, including payor, accountable care organization (ACO), independent physician association (IPA) and value-based care arrangements for primary care and home health services
• Medicare billing, enrollment, and conditions of participation rules
• coding/reimbursement and revenue cycle management
• assisting in compliance reviews of clinical operations
• Coordination with, and provision of subject matter expertise to, other internal teams to respond to governmental or payor investigations relating to primary care or home health care delivery
• participate in diligence review and integration of mergers & acquisitions
• coordinate with Humana privacy and HIPAA teams to address patient consent and privacy and security matters
• Extensive interaction with C-Suite and other senior executives to counsel on these matters and participate in briefings to the Board of Directors or Committees of the Board on material matters and developments.
• Serve as a key leader in the company's Law Department, helping with department management, including organization and structuring, talent evaluation, management and rationalization, budgeting decisions, and strategy.

Qualifications

Juris Doctor (JD) from an accredited law school; licensed to practice law in relevant jurisdiction. Minimum of 15 years of legal experience, including significant experience in primary care, home care or clinical delivery operations. Prior in-house counsel experience preferred. Exceptional communication, negotiation, and organizational skills. Proven ability to manage complex projects and influence at the executive level.

Preferred Attributes

Legal expertise: A strong background in healthcare law, including experience with corporate governance, compliance, and risk management. Business acumen: Strategic thinker with the ability to understand how the business operates and to provide strategic legal advice that aligns with business goals. Communication and negotiation: Strong skills in drafting, negotiation, and clear communication with both legal and non-legal stakeholders. Industry knowledge: Familiarity with the specific healthcare industry the company operates in, whether it's pharmaceuticals, a hospital system, or healthcare technology. High integrity and sound judgment. Embrace change management and rethinking existing processes.

Scheduled Weekly Hours 40

About Us: Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Equal Opportunity Employer: It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our accessibility resources at https://www.humana.com/legal/accessibility-resources?source=Humana_Website.