Legal Counsel - Provider Network Services

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

In this position, you will support the Provider Network Services legal and business teams with respect to a wide range of health care provider matters including, but not limited to: complex provider contract negotiations for Commercial, Medicare, Medicaid and Specialty lines of business; development and negotiation of value-based arrangements; pre-arbitration/litigation dispute resolution; credentialing, regulatory and risk management support; and general legal support for both participating provider networks and out of network providers in your assigned region. The attorney may also be asked to provide support for Medical Management and Utilization Management areas.

***The ideal candidate will sit mid-Atlantic or Northeast with hybrid/remote possibility***

This support may range from tasks such as the following, as they relate to your assigned region of the country:

• advising the business related to regulatory exams, inquiries, and filings where they involve provider network matters;

• advising, prioritizing, and mitigation planning regarding legal risks related to provider network relationships;

• providing provider contracting support, including support of complex provider health care system negotiations and risk-based arrangements;

• working with the business and internal and external counsel to resolve provider disputes prior to arbitration/litigation;

• collaborating with the business on the development and review of sensitive internal and external communications to various stakeholders (senior executives, regulators, lawmakers, advocates, members);

• collaborating with Medicare and Medicaid counsel to implement federal and state specific legal research involving provider network services for government lines of business;

• serving as specific subject matter expert for assigned areas related to health care provider issues;

• providing day-to-day risk management support for internal business clients responsible for provider networks in your assigned region

The attorney in this role will be expected to provide proactive risk management support and to assist in identifying and tracking policies and practices that can lead to various issues. You will identify business and legal risks and provide solutions that balance legal issues and business objectives. You will be expected to develop a keen understanding of various operational systems and internal governance and to work diligently to develop and maintain positive relationships with various clients.

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

• Demonstrated business judgment and acumen

• Superior oral and written communication skills

• High level of interpersonal skills and ability to manage multiple responsibilities

• Actively practicing attorney with 5+ years demonstrated experience in a law firm and/or in-house setting: experience with healthcare or other regulatory matters, experience drafting and negotiating complex contracts and/or interacting with government regulators or agencies with respect to healthcare matters
• Admitted to practice law in at least one state and in good standing

• 3+ years of experience with contracts and related issues

• Ability to travel up to 5% (including by plane)

• Experience with utilization management processes and regulations preferred

• Demonstrated business judgment and acumen required;

• Superior oral and written communication skills required;

• High level of interpersonal skills and ability to manage multiple responsibilities required;

Juris Doctor from ABA-accredited institution required

The typical pay range for this role is: