DescriptionRemote Position - United States
POSITION OVERVIEW
The Assistant Counsel is a hands-on, individual-contributor attorney serving as a key legal partner to Harbor Health's health plan and clinical operations. Reporting to the Chief Legal Officer, this role is the primary drafting, reviewing, and negotiating resource for the high volume of commercial agreements generated by a fast-growing pay-vider operating simultaneously as an insurer, a multi-specialty medical group, and a value-based care organization - spanning provider, payer, and vendor contracting; delegated entity oversight; network development; claims, appeals, and grievances; and regulatory compliance.
The ideal candidate pairs strong health care regulatory knowledge and sophisticated commercial contracting skill with sharp business acumen, thrives owning a heavy and varied docket in a fast-moving legal function, and builds trusted, collaborative relationships across network development, provider relations, product, actuarial, compliance, clinical operations, and finance.
POSITION DUTIES & RESPONSIBILITIES
I. Health Plan, Payer & Network Contracting
- Provider network agreements: Agreements with primary care, specialty, ancillary, facility, and hospital providers, including fee schedules, value-based/risk-sharing exhibits, credentialing terms, and amendment/termination provisions.
- Payer & CMS contracts: Value-based, shared-savings, and full-risk payer arrangements (attribution, quality metrics, reconciliation), plus CMS program agreements (e.g., ACO LEAD, MSSP) covering data-sharing and beneficiary alignment.
- Delegated entities: Delegation agreements with TPAs, PBMs, behavioral health and utilization management vendors, plus ongoing oversight, compliance monitoring, remediation, and regulatory reporting.
- Employer & Marketplace: Employer group plan, ASA, broker, and stop-loss agreements; ACA Marketplace issuer, QHP certification, and enrollment-platform agreements as Harbor's employer and Marketplace books scale.
- Claims & payment integrity: Claims adjudication, coordination of benefits, appeals and grievances, and payment integrity vendor agreements.
II. Clinical Operations & Medical Group Contracting
- Physician & clinician agreements: Physician and advanced practice provider employment, professional services, and medical director agreements, including restrictive covenant/compensation provisions (per Texas law) and locum tenens arrangements.
- Specialty & facility affiliations: Agreements with specialty partners (cardiology, dermatology, rheumatology, endocrinology, behavioral health, infusion) and hospitals/ancillary providers for referral, coverage, and co-management arrangements.
- Facilities & vendors: Lease, amendment, and build-out agreements for clinics, express care sites, labs, and mobile health units; laboratory, imaging, DME, staffing, and other clinical vendor agreements.
- Technology & privacy: EHR, care-coordination, and analytics/SaaS agreements, along with related BAAs and data-sharing agreements under HIPAA and Texas privacy law.
III. Regulatory Compliance & Government Affairs
- Advise & support with Compliance to ensure adherence to Texas and federal health care laws applicable to insurers, medical groups, and delegated entities; support TDI, CMS, and other regulatory exams, audits, inquiries, and complaint responses.
- Support legally compliant implementation of clinical programs, quality initiatives, and utilization management controls.
- Monitor and communicate TDI, CMS, and other rulemaking and legislative developments, translating complex regulatory language into actionable guidance and internal resources (e.g., newsletters, practice briefs).
- Perform regulatory research to support policy development, with a focus on the Texas insurance market, TDI guidance, and NAIC model act adoption.
IV. Cross-Functional Partnership
- Partner with business leaders across departments to assess legal implications of key decisions, and integrate regulatory/contractual considerations into health plan and clinical operations.
- Support compliance program design and internal audits/reviews to identify risks and improvement opportunities.
- Oversee implementation of Harbor Health's contract lifecycle management (CLM) solution and ensure adherence to best practices.
DESIRED PROFESSIONAL SKILLS & EXPERIENCE
Required
- J.D. from an accredited law school and an active license to practice law in Texas or another U.S. state (with willingness to obtain Texas licensure/registration promptly).
- 6-8 years of relevant legal experience, including 1-2 years in-house, with substantial hands-on transactional contract drafting/negotiation experience.
- Prior in-house or law firm experience representing a health plan, managed care organization, or health system, with exposure to both payer- and provider-side contracting.
- Demonstrated skill drafting and negotiating a high volume and variety of commercial agreements (provider, payer/risk, delegation, vendor/technology, real estate).
- Working knowledge of health care regulatory requirements for health plan and clinical operations, including claims administration, provider contracting, and delegated entity oversight.
- Strong business acumen; proven ability to manage a large, varied docket, meet regulatory/business deadlines, and build relationships with regulators, counterparties, and internal partners.
- Outstanding communication and interpersonal skills, with the ability to work across departmental lines and negotiate directly with external counterparties.
- Proactive, solutions-oriented mindset able to navigate ambiguity and help scale legal and contracting processes in a fast-growing organization.
- High level of personal integrity, professionalism, and intellectual curiosity; ability to manage multiple tasks efficiently with a strong sense of urgency.
Preferred
- Experience negotiating technology, data-sharing, and SaaS agreements in a regulated health care environment, including BAAs and data use agreements.
- Experience with the ACA and Health Insurance Marketplace, including QHP certification and issuer agreements.
- Advanced knowledge of the ACA, ERISA, HIPAA, and the No Surprises Act/balance billing rules.
- Experience with CMS value-based care models (e.g., ACO LEAD) or other Medicare/Medicaid value-based/risk arrangements.
- Certification in Healthcare Compliance (CHC) or similar credential.
- Prior in-house experience at a health insurer, ACO, or integrated delivery system.
- Experience with M&A or integration of clinical practices/operations, including transition services agreements and post-closing matters.
WHAT WE OFFER
- A high-visibility seat shaping the contracting practice and legal, regulatory, and compliance function of a fast-growing, vertically integrated pay-vider as Harbor Health scales its insurance products and clinic footprint across Texas.
- A collaborative, dynamic, and mission-driven culture, with competitive salary and benefits.
- Professional development and growth opportunities.
