Litigation Attorney - Managed Care & Reimbursement

Overview

Title: Litigation Attorney-Managed Care & ReimbursementSeated: Saint Clare's Health in Boonton, NJReporting to: Corporate Vice President - Claims Dispute Resolution

Prime Healthcare is seeking an experienced healthcare attorney to join our corporate Legal team supporting managed care and hospital reimbursement matters.

This is an opportunity to bring your litigation experience in-house and take meaningful ownership of payer-provider disputes, hospital reimbursement matters, claims disputes, arbitration, mediation, and litigation. You will work on complex matters with significant business impact while partnering with Legal and operational leaders across the organization.

Responsibilities

The successful candidate will have substantial experience working with managed care plans on reimbursement issues.  This may include resolving disputed claims through mediation, arbitration, and litigation including court proceedings, hearings, motions, and other litigation matters. This may also include payor relations efforts through joint operations committees or experience with managed care contracts.

What You'll Do

In this role, you will manage and support matters involving:

• Healthcare and health plan reimbursement and payment disputes
• Managed care, payer-provider, and claims-related disputesArbitration, mediation, hearings, and litigationDrafting pleadings, motions, discovery, filings, and other legal documents
• Managing matters throughout the dispute-resolution processAssessing legal and business risks and developing practical case strategies
• Negotiating and advocating on reimbursement and payer-related matters
• Supporting managed care contracts and payer-relations matters, including joint operating committees, as applicableCollaborating with Legal and internal business partners on managed care and reimbursement issues

This role offers the opportunity to take hands-on ownership of active matters while developing a strong understanding of Prime Healthcare's contracts, operations, systems, and business priorities.

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Qualifications

What We’re Looking For

The ideal candidate will have:

A Juris Doctor (J.D.) degree from an ABA-accredited law school.

An active license to practice law in Illinois or New Jersey.

Relevant experience with a reputable law firm or in-house legal department.

Significant experience with managed care plans, health plans, and hospital/provider reimbursement matters.

Proven ability to independently manage litigation through all stages, including pleadings, discovery, motion practice, hearings, and court appearances.

Experience with managed care contracting, payer relations, the Knox-Keene Act is a plus.

Required qualifications:

A law degree from an ABA accredited law school.

Illinois or New Jersey license to practice law.

At least 3 years of experience, preferably at a reputable law firm or in-house legal department.

Experience handling health plan and/or hospital reimbursement litigation including payment disputes, managed care disputes, arbitrations, court proceedings, and claims related matters.

Proven ability to manage litigation matters independently, including pleadings, discovery, motions, hearings, and court appearances.

Trial and courtroom experience preferred.

Exceptional written, verbal, advocacy, and negotiation skills.

Pay Transparency

Prime Healthcare offers competitive compensation and a comprehensive benefits package that provides employees the flexibility to tailor benefits according to their individual needs. Our Total Rewards package includes, but is not limited to, paid time off, a 401K retirement plan, medical, dental, and vision coverage, tuition reimbursement, and many more voluntary benefit options.  Benefits may vary based on employment status, i.e. full-time, part-time, per diem or temporary.  A reasonable compensation estimate for this role, which includes estimated wages, benefits, and other forms of compensation, is $249,600.00 to $300,726.40 on an annualized basis. The exact starting compensation to be offered will be determined at the time of selecting an applicant for hire, in which a wide range of factors will be considered, including but not limited to, skillset, years of applicable experience, education, credentials and licensure.

Employment Status

Full Time

Shift

Days

Equal Employment Opportunity

Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf