Overview
This role is for an Assistant Counsel serving as a key legal partner to a fast-growing health plan and clinical operations organization. Reporting to the Chief Legal Officer, the attorney will primarily draft, review, and negotiate a high volume of commercial agreements across provider, payer, and vendor contracting; delegated entity oversight; network development; claims, appeals, and grievances; and regulatory compliance.
Responsibilities
Health Plan, Payer & Network Contracting
- Draft and negotiate provider network agreements including fee schedules, value-based/risk-sharing exhibits, credentialing terms, and amendment/termination provisions.
- Manage payer and CMS contracts such as value-based, shared-savings, and full-risk arrangements, including CMS programs like ACO LEAD and MSSP.
- Oversee delegation agreements with TPAs, PBMs, behavioral health, and utilization management vendors, including compliance monitoring and regulatory reporting.
- Handle employer group plan, ASA, broker, stop-loss agreements, and ACA Marketplace issuer, QHP certification, and enrollment-platform agreements.
- Manage claims adjudication, coordination of benefits, appeals and grievances, and payment integrity vendor agreements.
Clinical Operations & Medical Group Contracting
- Draft physician and clinician employment, professional services, and medical director agreements, including restrictive covenant and compensation provisions under Texas law.
- Negotiate specialty and facility affiliations, including referral, coverage, and co-management arrangements.
- Manage lease, amendment, and build-out agreements for clinics and other health sites, as well as clinical vendor agreements.
- Handle technology and privacy agreements including EHR, care coordination, analytics/SaaS, BAAs, and data-sharing agreements under HIPAA and Texas privacy law.
Regulatory Compliance & Government Affairs
- Advise on compliance with Texas and federal health care laws applicable to insurers, medical groups, and delegated entities.
- Support regulatory exams, audits, inquiries, and complaint responses.
- Assist with legally compliant implementation of clinical programs and quality initiatives.
- Monitor and communicate regulatory and legislative developments, translating complex rules into actionable guidance.
- Conduct regulatory research focused on Texas insurance market and NAIC model act adoption.
Cross-Functional Partnership
- Collaborate with business leaders to assess legal implications and integrate regulatory and contractual considerations.
- Support compliance program design and internal audits to identify risks and improvements.
- Oversee contract lifecycle management solution implementation and ensure best practices.
Requirements
- J.D. from an accredited law school and active license to practice law in Texas or another U.S. state, with willingness to obtain Texas licensure promptly.
- 6–8 years of relevant legal experience, including 1–2 years in-house, with substantial hands-on transactional contract drafting and negotiation.
- Experience representing a health plan, managed care organization, or health system with exposure to both payer- and provider-side contracting.
- Proven ability drafting and negotiating a high volume and variety of commercial agreements.
- Working knowledge of health care regulatory requirements for health plan and clinical operations.
- Strong business acumen and ability to manage a large, varied docket and meet deadlines.
- Excellent communication and interpersonal skills.
- Proactive, solutions-oriented mindset with ability to navigate ambiguity.
- High level of integrity, professionalism, and intellectual curiosity.
Preferred Qualifications
- Experience negotiating technology, data-sharing, and SaaS agreements in regulated health care environments.
- Familiarity with ACA and Health Insurance Marketplace including QHP certification.
- Advanced knowledge of ACA, ERISA, HIPAA, and No Surprises Act/balance billing rules.
- Experience with CMS value-based care models or other Medicare/Medicaid risk arrangements.
- Certification in Healthcare Compliance (CHC) or similar.
- Prior in-house experience at a health insurer, ACO, or integrated delivery system.
- Experience with M&A or integration of clinical practices and operations.
Compensation & Benefits
- Competitive salary and benefits.
- Professional development and growth opportunities.
- Opportunity to shape contracting and legal functions in a fast-growing, vertically integrated health care organization.
Location
- Remote position within the United States
Additional Information
- This is a full-time exempt position.
- Minimum experience required: 6 years.
- No management responsibilities.
Equal Employment Opportunity
The employer is an Equal Opportunity Employer and does not discriminate based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, or any other protected characteristic. Applications from diverse backgrounds are encouraged.