CVS Health

Atlanta, Georgia, United States


Posted over 1 month ago

Job Description

Job Description
As Legal Counsel, you will provide legal guidance, interpretation, and advice and recommendations to internal stake holders and senior/executive management regarding Medicare Advantage and Part D products offered by the Aetna Medicare business unit within the CVS Health enterprise. Your work will include collaborating with others in the CVS Health enterprise on company-wide initiatives that involve Medicare with an emphasis on supporting provider facing matters and advising and assisting on risk adjustment, medical loss ratios, special needs plans and associated products, and innovative care models. You will work closely with other attorneys within the CVS Health legal department including local counsel who cover specific states, Compliance, and Governmental Affairs. You will be assigned to specific areas of work for which you will serve as the subject matter expert or work with the senior Medicare counsel.

The types of work you may assist with may also include:
* researching laws, regulations and CMS guidance;
* commenting on proposed rules;
* monitoring enforcement actions and advising business teams on their implications;
* working with the Medicare products area on product design that includes supplemental benefits;
* reviewing provider and member facing communications;
* drafting and negotiating provider, vendor and group contracts;
* assisting with member and provider disputes;
* providing counsel on Medicare provider facing matters and other coverage and care issues;

The attorney in this role will be expected to provide sound legal guidance including proactive legal counsel for the Medicare Advantage and Part D to assist the business in meeting its goals and to prevent and/or address regulatory issues. You will identify business and legal risks and provide solutions which balance legal risks and business objectives. You will be expected to develop a keen understanding of all aspects of Medicare working closely with all levels of the Medicare business staff as well as other enterprise staff. You will work to develop and maintain positive relationships with various clients including Aetna Medicare staff that will require close collaboration and teamwork. You will be expected to use strong research and analytical skills to analyze complex issues and provide clear advice to our business partners.

In order to be successful in this role you must exhibit the following:

* Strong teamwork and collaboration skills;
* Demonstrated experience with research, drafting and interpretations of laws, regulations or government opinions;
* Direct experience with handling client legal issues independently with little to no supervision;
* Demonstrated strong business judgment and acumen;
* Superior oral and written communication skills;
* Excellent organization and time management skills;
* High level of interpersonal skills and ability to manage multiple responsibilities and priorities;
* Excellent legal acumen, drafting and analytical skills; and
* Experience with policies, manuals, licensure, payment matters or other skills that can be applied to Medicare.

Pay Range
The typical pay range for this role is:
Minimum: 120,000
Maximum: 265,000

Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location.

Required Qualifications
* Juris Doctor from ABA-accredited institution;
* Bar admission in good standing;
* Minimum of 5+ years of direct legal experience, including judicial clerkships;
Ability to travel up to 5%

COVID Requirements

COVID-19 Vaccination Requirement
CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated.

You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.

Preferred Qualifications
* Experience with Medicare, Medicaid or governmental work such as federal insurance laws, CMS policies and guidance such as manuals (Medicare experience is preferred);
* Litigation or other legal experience with complex regulatory, contracting and/or payors and plan issues;
* Experience with Government Program (Medicaid/Medicare) legal work such as coverage, benefits, appeals and grievances, contracting, provider, financial, and/or medical loss ratio issues;
* At least 4 years experience in a law firm health care practice, legal in-house experience at a managed care company, insurance plan, provider, or governmental position preferred.

Juris Doctor from ABA-accredited institution;

Business Overview
Bring your heart to CVS Health
Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver.

Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable.
We strive to promote and sustain a culture of diversity, inclusion and belonging every day.
CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.