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Chief Review Judge/Appeals Administrator
WMS 3 – DLS | Permanent | Olympia, WA
What Health Care Authority can offer you!
- A healthy work/life balance, including alternative/flexible schedules and mobile working
- A clear agency mission that drives our work and is person-centered
- Competitive Salary
- A great total compensation and benefit package
- A safe, pleasant workplace in a convenient location
Within HCA, the Division of Legal Services (DLS) provides centralized legal support to all HCA divisions at all employee levels to mitigate risks, comply with changing state and federal laws, and assist HCA in accomplishing its goals. DLS supports all programs within HCA.
The Chief Review Judge/Appeals Administrator reports directly to the Chief Legal Officer and provides legal, policy, and administrative support to ensure the HCA meets its legal requirements under state and federal law to provide fair, impartial adjudicative proceedings. Additionally, this position may preside over administrative hearings related to the Public Employees Benefit Board (PEBB) or the School Employee Benefit Board (SEBB).
This position has three roles within HCA.
The agency’s Appeals Administrator.
The agency’s Chief Review Judge responsible for the HCA Board of Appeals.
Presiding officer for PEBB/SEBB administrative hearings.
Some of what you will do:
- Plans, leads, and develops adjudicative proceedings (hearings and appeals) processes ensuring compliance with all state and federal laws, regulations and policies, insuring due process under the law.
Chief Review Judge/Appeals Administrator
- Manages the interagency agreement with the Office of Administrative Hearings (OAH) to ensure that OAH conducts hearings in a manner that is timely and fair, affords due process, and that decisions are legally accurate and supported by a complete record in compliance with Chapter 34.05 RCW and 42 CFR 431 Part E, and other relevant laws and regulations.
- Oversees the proper scheduling and tactical operations of the hearings system statewide.
- Designs and implements necessary changes to the administrative hearings program based on changes in state or federal health care law in consultation and collaboration with subject matter experts, stakeholders, internal program managers, and OAH.
- Develops, maintains, and publishes all hearings-related forms and publications in coordination with agency program managers and the Communications Division.
Management of the Board of Appeals
- Plans, leads, and directs the operations of the Board of Appeals ensuring the highest quality of judicial reasoning and application of law.
- Directs and supervises the work of Review Judges who (1) review and correct decisions of Administrative Law Judges or (2) presides over nursing home rates administrative hearings, by applying laws to the facts to reach legal conclusions, and issue legally binding final orders under delegated authority of the HCA Director.
- Effectively manages employees within the established personnel rules, policies, procedures, and collective bargaining agreements, as appropriate.
- Set strategic goals for the Board of Appeals focusing on timely, fair resolution to issues, in compliance with law.
Presiding Officer for PEBB and SEBB Administrative Hearings
- Presides over administrative hearings in accordance with Chapter 182-16 WAC and Chapter 34.05 RCW by applying facts to law, creating a complete record, and issuing a final agency decision appealable to state superior court.
- Refers cases to the Office of Administrative Hearings when appropriate
- Working with BOA support team, schedules hearings, pre-hearing conference, setting discovery deadlines (when applicable), ruling on motions, resolving issues, and ensuring due process at all time.
What we are looking for (Required Qualifications):
- Law degree from an accredited law school.
- Licensed by the Washington State Bar Association and in good standing.
- Strong leadership and management skills that ensure accountability, effectiveness, and high level of ethical integrity, including adherence to the Rules of Professional Conduct.
- Five years’ experience with administrative hearings under the Administrative Procedures Act, representing a governmental agency in front of a tribunal, or other similar legal experience in public sector judicial or quasi-judicial setting.
- Experience directly supervising professional level staff.
Required skills and competencies:
- Excellent oral and written communication skills including conflict de-escalation.
- Knowledge and skills in litigation, negotiation, and mediation/conflict resolution.
- Excellent public speaking skills, ability to assess training needs ability to develop and deliver training to wide variety of audiences. Ability to use diplomacy, negotiating, problem solving, and consultation skills when communicating.
- Demonstrates personal accountability.
- Experience in personnel management, staff development, and knowledge of regulations related to personnel and supervisory management in the public sector.
- Ability manage time and organize work-using systems thinking.
- Advanced knowledge of information technology and skills in working with systems and software, including proficiency with Microsoft Office applications.
- Knowledge of and adherence to state ethics law.
- Knowledge of state and federal policies, laws, and regulations related to state and federal medical assistance programs.
- Knowledge of laws and issues related to administration of the Public Employees Benefit Board program (e.g., COBRA, ERISA, Internal Revenue Code, self-insurance health plans, outside third party administration issues, coordination of benefits, long-term disability, health savings accounts, and flexible spending accounts).
- Knowledge of healthcare delivery methods, national healthcare reform efforts, and trends.
- Knowledge of or experience in state contracts and acquisitions; vendor disputes; intellectual property; internet/computer law; Public Records Act/Open Public Meetings Act; and privacy laws.
- Knowledge and experience drafting, negotiating, and managing contracts in state government.
The Washington State Health Care Authority purchases health care for more than 2 million Washington residents through Apple Health (Medicaid), the Public Employees Benefits Board (PEBB) Program, and, beginning in 2020, the School Employees Benefits Board (SEBB) Program. As the largest health care purchaser in the state, we lead the effort to transform health care, helping ensure Washington residents have access to better health and better care at a lower cost.
Our Mission – Provide high-quality health care through innovative health policies and purchasing strategies.
Our Vision – A healthier Washington
Our Values – People first, Respect, Leadership, Public Service, Innovation, Collaboration, Service Excellence, and Stewardship!
How to Apply:
To apply for this position you will need to complete your profile and attach:
- A cover letter
- Current resume
- Three professional references
Please apply for Chief Review Judge/Appeals Administrator (DLS) through Careers.wa.gov
If you have questions about the process, or need reasonable accommodation, please contact the recruiter before the posting closes. The candidate pool certified for this recruitment may be used to fill future similar vacancies for up to the next six months.
Washington State is an equal opportunity employer. Persons with disabilities needing assistance in the application process, or those needing this job announcement in an alternative format may call the Human Resources Office at 360.725.0945 or email Sidra.Fields@hca.wa.gov
* Prior to a new hire, a background check including criminal record history will be conducted. Information from the background check will not necessarily preclude employment but will be considered in determining the applicant’s suitability and competence to perform in the position. *
DIRECTOR OF CLINICAL SERVICES PROJECTS
The School of Medicine has an outstanding opportunity for a Director of Clinical Services Projects.
Under the general guidance of the Director of External Business Relations, the Director of Clinical Services Projects is primarily responsible for managing contractual arrangements and related faculty deployment and compliance issues associated with School of Medicine (“SoM”) faculty efforts to provide clinical and educational services to entities outside of the UW Medicine system, and additionally responsible for coordinating with other stakeholders as needed on clinical services arrangements involving UW Medicine component entities. The work includes a mix of short-term projects to address operational and business aspects of developing agreements, as well as contributing guidance regarding longer-term systemic change and policy development. The Director will often work in a lead role but may also work as a member of a team depending on the project or assignment. These clinical services arrangements and associated projects frequently involve close interaction with the School’s Department and Division administrators, with the UW Medicine component entity hospitals (UW Medical Center, Harborview Medical Center, Northwest Hospital & Medical Center, and Valley Medical Center),with affiliated faculty practice plans (UWP and CUMG), and with closely-affiliated hospitals (Seattle Children’s, Seattle Cancer Care Alliance, and the Veteran’s Administration Puget Sound, Seattle)
This position has a primary reporting relationship to the Director of External Business Relations and has a close working relationship with the Senior Director of Business and Regulatory Affairs and with the other Directors in the Business Unit (Director of Personnel Policy, Director of HR Policy, Director of Personnel Guidance, Director of Regulatory Guidance), as well as with the Director of Business Planning and Analysis for UW Medicine, the UW Medicine Compliance Office, School of Medicine Department Directors and Division Administrators, and the Vice Dean for Administration and Finance as indicated.
This position is responsible for providing contract consultation, drafting and negotiation services across a spectrum of business relationships arising primarily in the clinical services and clinical education arenas, but also in the research arena, in which the SoM operates. The person who holds this position needs to understand the regulatory and policy framework that governs contracting at UW, given its status as a public university and agency of the State of Washington. Additionally, the individual who holds this position needs to understand the role of SoM within UW Medicine, which operates as a health system and involves multiple hospitals, practice plans, and neighborhood clinics as well as its close affiliations with other local hospitals and research institutions. It is important to appreciate the organizational structure and leadership structure within the SoM, which comprises 19 clinical Departments, with several Departments being spread across multiple divisions reflecting the diversity of clinical specialty and subspecialty areas represented within the SoM. Finally, an understanding of the role and relationship of the SoM within the greater context of the University is also critical.
This position requires an individual who has substantive skills in contracting and business operations, a strong service orientation and a demonstrated ability to work closely and credibly with academic physicians and highly trained professional staff on business matters that are often exceedingly time sensitive and can, at times, involve highly sophisticated and heavily regulated clinical delivery methods, including telemedicine, digital medicine, and clinical trials. Finally, a demonstrated ability to understand and work with highly ambiguous subject matter is necessary when working to create consensus among faculty, staff and administrators regarding action plans.
SoM Clinical Service Agreement Responsibilities
Provide primary leadership in the management of SoM clinical services arrangements. Representative projects will include, but not be limited to the following:
- Draft and assist in negotiating new SoM clinical service agreements, including but not limited to agreements with healthcare entities, healthcare or health advocacy organizations, government agencies, sports teams, pharmaceutical companies, device manufacturers, entities conducting clinical research (including clinical trials) and vendors, for direct patient care services, patient consultation services, clinically-related consultations services, and medical director services. This process involves complex considerations that include, but are not limited to, the following: faculty status, credentialing/privileging, telemedicine and other new and emerging technologies, licensing, reimbursement, risk management, indemnification, confidentiality provisions, reporting, compliance issues, research-related issues, intellectual property issues, and insurance/liability coverage.
- Review and update existing SoM clinical service agreements to reflect changing regulatory rules and/or marketplace factors, amendments to scope of work or term, or other needed changes.
- Assisting in developing or revising policies and internal operating guidance related to the issues that arise in the clinical service agreement arena.
- Interface and coordinate with legal counsel in the Attorney General’s Office (“AGO”) as appropriate in the advice and guidance provided.
- Interface and coordinate with legal counsel for the UWP and CUMG provider practice plans as indicated regarding billing issues and practice plan obligations that may affect clinical service agreement provisions.
- Interface and coordinate with Procurement Services on purchase transactions involving clinically-related goods and services, including locum tenens contracts.
SoM Educational Services Agreement Responsibilities
- Draft and assist in negotiating new SoM clinically-related educational service agreements. This process is primarily related to vendors, and involves complex considerations that include, but are not limited to, the following: risk management, indemnification, confidentiality provisions, licensing issues, conflict of interest issues, compliance issues, reporting, intellectual property issues, and insurance/liability coverage.
- Review and update existing SoM educational service agreements to reflect changing regulatory rules and/or marketplace factors, amendments to scope of work or term, or other needed changes.
- Interface and coordinate with the AGO as appropriate in the advice and guidance provided.
- Sites of Practice
– Provide review and advice to the Sites of Practice (“SOP”) Administrator, SOP Committee, and, upon request, the Chief Medical Officer (“CMO”), regarding SOP approval issues that are related to SoM faculty’s external clinical activities.
– Advise/assist department/division administrators regarding SOP issues related to faculty clinical activity.
– Together with counsel for UWP, review SOP submissions and issues, and advise the SOP administrator regarding appropriate documentation to present to the Committee for vote.
– Review and draft revisions as needed to SOP policies, together with UWP counsel, at the request of the CMO (SOP Committee Chair).
– Advise the CMO as requested regarding SOP issues.
– Respond to Committee questions regarding submissions for electronic vote.
– Attend SOP Committee meetings.
- Policy/Program Projects
– Working with departments/divisions and other SoM/UW Medicine stakeholders as indicated, draft or review and revise various SoM/UW Medicine policies affecting clinical services and educational service agreements. Subject policies address issues such as licensing, credentialing and privileging, federal and state law obligations, quality improvement and risk management issues, research-related issues, and similar issues,
– Working with departments/divisions and other SoM/UW Medicine stakeholders as indicated, draft or review and revise other documents related to clinical and educational services agreements. These include standardized UW Medicine documents and/or language used in standardized UW Medicine documents.
- Provide operational leadership and liaison support to AAG as needed for SoM Academic Affairs regarding
– SoM MD student Service Learning Projects; and
– Issues related to SoM non-GME educational affiliation agreements with clinical rotation sites, which are located primarily across the five-state WWAMI region.
- Work in coordination and support of projects assigned to other members of the Business Unit and related UW Medicine positions, including:
– Work with the Directory of Regulatory Guidance on issues related to outside work and goods/services agreements.
– Work with UW Medicine Compliance on compliance related issues.
– Work with the Director of Personnel Policy on personnel related issues.
– Work with the office of Graduate Medical Education (GME) on GME aspects of issues related to clinical services provided by fellows.
– Work with the Vice Dean for Administration and Finance on all of the issues listed above as indicated/requested
- Training and presentations to various groups on clinical services arrangements and associated process, business and compliance issues.
- Other duties as assigned.
Work in coordination and support of projects assigned to other members of the SoM Finance and Administration group on an as needed basis.
- Master’s Degree in Business Administration, Healthcare Administration or similar degree in a related field of study or law degree.
- Minimum of five years’ experience in an academic, healthcare, or health research environment
- Proven ability to function independently and effectively in a large organization
- Proven leadership skills to facilitate solutions-oriented approaches and cooperative decision-making
- Demonstrated ability to maintain harmonious working relationships, bring consensus among those involved and facilitate action plans
- Demonstrated ability to understand and work with diverse subject matter and to create and effectively address complex administrative issues
- Demonstrated understanding of the national, regional and local regulatory and legal issues impacting academic medical centers and clinical providers
- Demonstrated knowledge of and experience with contract negotiation, drafting and execution
- Demonstrated familiarity with the contractual business issues that arise in the normal course of academic medical center activities
- A track record of creative problem solving
- Excellent communication skills (written and verbally)
- Demonstrated ability to work closely and credibly with others, including faculty (physicians and researchers) and staff
- Experience leading committee processes
- Excellent Microsoft Word skills
- Substantial experience in an academic medical environment
- Experience with healthcare risk or insurance issues
- Experience working with healthcare services providers on clinically-related issues
- Administrative and management-level experience
- Experience generating standard reports, e.g., using Microsoft Excel
Corporate Counsel – Seattle, WA
We are seeking a Corporate Counsel to be responsible, under the guidance of the Deputy General Counsel, for providing general legal services and assigned specific projects for Providence St. Joseph Health and its affiliated entities including Swedish Health Services (collectively “Providence”). The Corporate Counsel provides legal advice, consultation, and policy analysis and interpretations of numerous areas of law and policy, and conducts research and analysis to provide policy recommendations.
In this position you will:
• Prepare written opinions and guidance for the executive management teams and other internal clients, and draft and review contracts for the organization with emphasis on physician and vendor agreements.
• Keep informed of opinions, orders, decisions and developments relating to hospital and physician legal requirements and other matters of interest.
• May be assigned responsibility for supervising of Associate Counsel and non-attorney staff and/or administrative duties with the Providence Department of Legal Affairs.
• Provides research and technical support and drafts legal opinions for the determination and resolution of complex legal issues.
• Participates in the supervision and preparation of defense in non-malpractice litigation matters, working directly and independently with outside counsel to develop the defense/briefs, overall litigation strategy, and guides outside counsel and supervises their work. Provides advice directly to client regarding litigation management, including whether a case should be tried or settled.
• Develop expertise in health care regulatory specialized areas of the law (e.g., Stark, Medicare reimbursement, privacy laws, etc.).
• Coordinate with the Chief Legal Officer, Deputy General Counsel, and Senior Corporate Counsel in providing assistance and guidance regarding Providence legal affairs.
• Prepares, drafts and reviews legal documents including, but not limited to, governing documents (e.g., articles, bylaws, etc.) and agreements in compliance with applicable statutes, regulations and policies.
• Provide analysis, advice and counsel for legal issues. Actively participates in providing regular and timely legal information as a continuing educational resource for Providence operations/ministries, including development of presentation materials, delivery of presentations, and development of written summaries regarding regulatory/legal changes affecting such operations/ministries.
• Remain current and knowledgeable with respect to issues affecting health care.
Required qualifications for this position include:
• Doctor of Jurisprudence degree from an accredited law school.
• Admission to state bar in Oregon, California or Washington.
• Minimum of eight (8) years of relevant experience.
PLEASE NOTE: This position sits onsite in Seattle, WA. 20% travel. Medical/Dental/Vision, 401(a), 403(b).
To apply, please go to: http://www.providenceiscalling.jobs, and enter job ID 187061.
Healthcare M&A Associate – Senior Level (Seattle or Los Angeles)
Davis Wright Tremaine is seeking a senior level associate with a minimum of five years of law firm experience in mergers and acquisitions, joint ventures and other significant business transactions. The ideal candidate will be able to lead smaller transactions and to second-chair larger and more complex transactions. Experience working on M&A in healthcare services and healthcare technology is highly preferred.
We seek candidates who will fit well with our Healthcare M&A team, each of whom has a combination of experience in M&A, the healthcare industry and regulatory issues. Candidates should have that experience or be willing to commit to develop it with the team.
Candidates must have excellent academic credentials and transactional skills. We prefer candidates with law firm experience, an entrepreneurial mindset, a strong client-service ethic and outstanding interpersonal skills. Active membership in the California State Bar or Washington State Bar is preferred. All replies confidential.
To apply, please upload a cover letter addressed to Bahareh Samanian, Director of Lawyer Recruiting; resume; deal sheet and law school transcript. Please specify how you heard about this position.
We are accepting submissions from third-party recruiters.
Director of Lawyer Recruiting
Tel: (206) 757-8782
Vice President, General Counsel
Confluence Health is seeking an in house Vice President, General Counsel to work in a diverse integrated healthcare setting. Key responsibilities include providing strategic leadership, management, and overall guidance in all legal service areas affecting Confluence Health and its affiliated corporations. The Vice President, General Counsel, assumes system-wide responsibilities for providing legal advice in matters of general corporate law, contracts, antitrust, managed care, patient care, litigation matters, real estate and regulatory law and coordinates outside legal services. [View PDF]
For a full job description and to apply on-line, go to https://www.healthcaresource.com/confluencehealth/index.cfm?fuseaction=search.jobDetails&template=dsp_job_details.cfm&cJobId=100010701.
For more information about Confluence Health visit our website at www.confluencehealth.org/careers. If you’d like to speak with a Recruiter directly, please email us at Rebecca.Wright@confluencehealth.org.
MultiCare Health System, a non-for- profit health care organization based in Tacoma, WA with more than 18,000 team members (including employees, providers and volunteers), is the largest community-based, locally governed health system in the state of Washington, with a comprehensive system of seven hospitals, numerous primary care, urgent care and specialty services (Immediate Clinic, MultiCare Indigo Urgent Care, Pulse Heart Institute, and MultiCare Rockwood Clinic, the largest multispecialty clinic in the Inland Northwest region), and growing behavioral health platform to include affiliation with Navos. MultiCare seeks a health care attorney to support its expanding health care operations and vision to be the Pacific Northwest’s highest value system of health. Preference will be given to applicants with at least 5 to 7 years’ experience in a) health care or related business transactions and regulatory matters in an in-house or law firm environment, and/or b) litigation (preferably medical malpractice and/or commercial litigation).
Primary responsibilities will include assisting the Senior Vice President and General Counsel in:
- providing strategic and transactional counsel to the corporate leadership team, administrative team and clinical leaders;
- advising on regulatory issues (HIPAA, reimbursement, Fraud and Abuse, Stark and Anti-kickback); and
- participating as a legal team member in managing risk. Experience with behavioral health issues, advising on information security/technology matters, payor contracting/health plans, clinical research issues, and physician-hospital arrangements and related business transactions in acute and ambulatory care settings is highly desirable.
Candidates should identify areas of interest or particular expertise regarding Risk Management, Behavioral Health, Medical Staff/Quality/Peer Review, Clinical Research, Payor Contracting/Health Plans, Information Services/Technology, Non-Profit Corporations law, Employment law, Health Care Transactions and Regulatory law (HIPAA, Stark, Anti-Kickback, Fraud & Abuse, etc). Highly effective communication, interpersonal, and conceptual analytical skills are essential. Position open until filled. Qualified applicants encouraged to expedite submissions.
MultiCare Health System is an Equal Opportunity Employer. Please note that MultiCare is in both directions a reverse commute from Seattle (35 minutes from I-90). If you are interested in the position please click on the link and apply: https://jobs.multicare.org/job/attorney-legal-services-52248/