ESSENTIAL DUTIES:

The Chief General Counsel (CGC), one of the most important members of the management team, is primarily responsible for overseeing compliance within an organization, and ensuring compliance with laws, regulatory requirements, policies and procedures, and leading corporate strategic and tactical legal initiatives, Data Privacy, Contracts, and Transactions.. As the compliance leader and subject matter expert, the CGC is responsible for establishing standards and implementing procedures to ensure that the compliance programs throughout the organization are effective and efficient in identifying, preventing, detecting and correcting noncompliance with applicable laws and regulations. Additionally this role provides senior management with effective advice on company strategies and their implementation, manages the legal function, and obtains and oversees the work of outside counsel.

The CGC has to provide reasonable assurance to senior management and the Board that there are effective and efficient policies and procedures in place, well understood and respected by all employees, and that the company is complying with all regulatory requirements.

RESPONSIBILITIES:

Defining the necessary level of knowledge on existing and emerging regulatory compliance requirements across the organization including identifying insurance risk, review of clinical programming, operational licensing, and review of all insurance plans. Developing the annual compliance work plan that reflects the organization's unique characteristics and periodically revising the compliance plan in light of changes.

• Overseeing and monitoring the implementation of the compliance program and guiding in a productive, professional way, the compliance teams.

• Providing guidance, advice, and/or training and educational programs, to improve business' understanding of related laws and regulatory requirements.

• Report functionally to the organization's board, typically through an audit or compliance committee. This reporting relationship provides each function with the necessary authority to effectively address their responsibilities. Providing strategic direction to the management team on compliance

• Preparing and presenting clear and concise compliance reports to the Board and coordinating efforts related to audits, reviews, and examinations.

• Interacting with regulators on compliance issues and monitoring external review processes.

• Developing policies and programs that encourage managers and employees to report suspected fraud and other improprieties, without fear of retaliation.

• Coordinating internal compliance review and monitoring activities, including periodic reviews of departments.

• Independently investigating and acting on matters related to compliance and/or corporate workplace legalities.

• Report administratively to the organization's CEO. This reporting relationship ensures that functional administration and resource allocation is not inappropriately influenced by operational areas subject to corporate compliance and internal audit activities.

• Have access to the entire organization per board direction, typically identified in the board approved program or charter. Compliance and internal audit professionals must have open access to the records and personnel of the organization to ensure unbiased results.

• Recognize and communicate that management is responsible for compliance, corporate compliance is not. Management is responsible for ensuring its activities comply with applicable laws, rules and regulations. This fact should be identified in the board-approved program or charter.

• Recognize and communicate that management is responsible for internal controls, internal audit is not. Management is responsible for ensuring that appropriate internal controls are implemented to meet organizational mission and strategic objectives. This fact should be identified in the board-approved program or charter.

• Have the authority to conduct investigations. In many cases, compliance and audit collaborate to conduct investigations. Depending upon the nature of the investigation, either function may work on their own or in collaboration with other functions like human resources, information technology, legal and security.

• Effectiveness and efficiency of operations.

• Reliability of financial reporting.

• Compliance with applicable laws and regulations.

GENERAL COUNCIL:

• Participates in the definition and development of corporate policies, procedures and programs and provides continuing counsel and guidance on legal matters and on legal implications of all matters.

• Serves as key lawyer/legal advisor on all major business transactions, including acquisitions, divestitures and joint ventures.

• Judges the merits of major court cases filed against or on behalf of the company, works with the appropriate executive(s) to define a strategic defense and approves settlements of disputes where warranted.

• Assumes ultimate responsibility for ensuring that the company conducts its business in compliance with applicable SEC et al. laws and regulations.

• Structures and manages the company's internal legal function

Oversees the selection, retention, management and evaluation of all outside counsel. Advises on legal aspects of the company's financing, including assessing and advising on current and future business structures and legal entities.

• Identifies new risks and projects through various intakes, including regular meetings with stakeholder leadership, legal, and external sources; and collaborates with the operators to implement compliance solutions.

• Oversees arrangements to include provider compensation, acquisition transactions and other provider related arrangements in order to document compliance with Anti-kickback statute and Stark Law.

• Understands and documents key processes, programs and initiatives.

• Works with internal/external attorneys to assess identified risk.

• Manages special projects, including root/cause analyses, data analytics, process improvement, and control development.

• Partners with other directors in compliance & leadership to manage larger compliance team.

• Represents Compliance Department at various business leadership meetings.

• Uses, protects, and discloses SCH patients' protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.

Education

1. Law degree and admission to the bar.

2. Minimum of four years' experience in a corporate legal environment

3. Experience working on matters of healthcare corporate governance.

EXPERIENCE:

• Managed Care experience. Excellent organizational and analytical skills required.Excellent research skills and experience with Medicare/Medicaid regulations.

• Experience in managing, drafting, reviewing and negotiating complex contracts. Candidates must have experience working at, supporting or negotiating for/with Managed Care/Insurance Organizations, Government Products (Medicare/Medicaid) experience, experience as it pertains to Health Plans, and a solid background in healthcare laws and regulations, to include, but not limited to, HIPAA, Stark, Privacy, Security, Risk Management, Provider Reimbursement, Fraud and Abuse. Risk mitigation experience.

• The ideal candidate will be one that has a demonstrated track record of being a proactive advisor and partner with the business teams. The individual must be comfortable in a fast paced environment that requires rapid turnaround on an array of high priority needs.