Responsible for leading the strategic development, implementation, and continuous improvement of Methodist Le Bonheur Healthcare's healthcare regulatory program. Serves as a trusted advisor to executive leadership on related legal, regulatory, operational, and reputational risk matters and provides counsel regarding healthcare regulatory compliance, business transactions, provider-related arrangements, government investigations, and organizational initiatives. Leads efforts to develop and implement a proactive and programmatic regulatory risk management model designed to identify, address, mitigate, and avoid healthcare regulatory risk across the enterprise. Models appropriate behavior as exemplified in MLH Mission, Vision and Values.
A Brief OverviewResponsible for leading the strategic development, implementation, and continuous improvement of Methodist Le Bonheur Healthcare's healthcare regulatory program. Serves as a trusted advisor to executive leadership on related legal, regulatory, operational, and reputational risk matters and provides counsel regarding healthcare regulatory compliance, business transactions, provider-related arrangements, government investigations, and organizational initiatives. Leads efforts to develop and implement a proactive and programmatic regulatory risk management model designed to identify, address, mitigate, and avoid healthcare regulatory risk across the enterprise. Models appropriate behavior as exemplified in MLH Mission, Vision and Values.
What you will do- Leads the development, implementation, and continuous improvement of enterprise-wide healthcare regulatory program designed to proactively identify, avoid, address, and mitigate regulatory-related legal, operational, financial, and reputational risks.
- Provides risk assessments and counsel on all aspects of compliance with state and federal health care operations and regulations, including federal and state fraud, waste and abuse laws; provides leadership and oversight regarding compliance with federal and state healthcare laws and regulations, accreditation standards, Conditions of Participation (CoPs), licensing requirements, privacy and security requirements, and ethical business conduct expectations.
- Serves as a trusted strategic legal and regulatory advisor to executive leadership regarding healthcare regulatory operations, physician enterprise initiatives, strategic transactions, business development activities, and enterprise risk management. Partners with business development, physician enterprise, operations, and affiliate leadership to structure and evaluate strategic initiatives, provider-related transactions, service line arrangements, acquisitions, affiliations, and other business arrangements to ensure legal and regulatory compliance while advancing organizational objectives.
- Monitors and interprets changes in laws, regulations, accreditation standards, Conditions of Participation, enforcement priorities, and industry best practices. Assesses organizational impact and develops implementation plans, policies, controls, and educational initiatives to ensure compliance.
- Monitors and interprets changes to and trends in government and legislative policies at the federal, state, or local level. Determines impact on the organization and advises senior management accordingly. Recommends and implements specific company responses to changes in governmental and legislative policies.
- Performs complex research and investigations and designs, drafts and submits documents concerning legal issues to maintain compliance with various regulations and provides legal interpretation of laws and regulations.
- Develops policies, procedures, governance frameworks, and operational standards that promote regulatory compliance, ethical business practices, and organizational accountability.
- Provides legal advice and assistance, including policy development and management support, on issues related to compliance and regulatory issues.
- Leads legal review and structuring of significant strategic, operational, physician, and business transactions to achieve organizational objectives while minimizing legal, regulatory, financial, and reputational risk.
- Provides legal guidance regarding marketing, advertising, public communications, patient testimonials, provider endorsements, photography, recordings, and related documentation to ensure compliance with applicable legal and regulatory requirements.
- Develops and implements system-wide education programs and best-practice guidance for executives, leaders, and operational teams regarding healthcare regulatory requirements and risk mitigation strategies.
- Collaborates closely with Compliance, Internal Audit, Risk Management, Privacy, Security, Physician Enterprise, Revenue Cycle, and Operational leaders to strengthen organizational compliance and risk management capabilities.
- Consults with and provides assistance to other colleagues in Legal services in a highly collaborative and team-oriented fashion. Provides risk assessments and counsel on all aspects of compliance with state and federal health care operations and regulations, including federal and state fraud, waste and abuse laws.
Education Qualifications- Required - Juris Doctorate Law
Experience Qualifications- Required - Minimum of ten (10) to fifteen (15) years of progressively responsible experience providing healthcare regulatory counsel, compliance support, risk management guidance, and transactional advice in a healthcare system, physician enterprise, law firm, or related environment, including experience advising executive leadership on complex strategic initiatives.
Skills and Abilities- Thorough knowledge and understanding of federal and state healthcare laws and regulations, including but not limited to Stark Law, Anti-Kickback Statute, False Claims Act, HIPAA, EMTALA, Conditions of Participation (CoPs), Medicare and Medicaid requirements, corporate compliance obligations, accreditation standards, licensing requirements, privacy and security regulations, and ethical business conduct requirements.
- Ability to understand and prepare complex written materials such as major contracts, business plans and policies and procedures.
- Ability to communicate verbally and non-verbally with all levels of Associates, executives, management, physicians and (if/when requested) Board of Directors.
- Ability to lead and motivate individuals and groups of people toward the accomplishment of work and organizational goals.
- Advanced skill in negotiating and conflict resolution with and between individuals and groups of people, including Associates, management and physicians.
- Ability to plan and schedule tasks and projects and to maintain control of own and others' workflow.
- Skill in developing and implementing long-range plans and programs.
- Ability to work without close supervision or professional guidance and to exercise independent judgment.
- Demonstrated expertise in healthcare transactions, provider-related arrangements, physician enterprise operations, mergers, acquisitions, affiliations, joint ventures, and other strategic business initiatives.
- Knowledge of enterprise risk management principles and best practices applicable to healthcare organizations.
- Ability to develop, implement, and oversee programmatic compliance, risk management, and regulatory initiatives across a complex healthcare system.
- Ability to design and deliver executive, physician, and operational education programs related to regulatory compliance, risk mitigation, healthcare transactions, privacy, billing compliance, and ethical business practices.
- Ability to interact effectively with government agencies, accreditation organizations, licensing bodies, and external counsel during audits, investigations, surveys, inquiries, and enforcement proceedings.
Licenses and Certifications- Required - Attorney - Board of Professional Responsibility (TN or MS Preferred)
Supervision Provided by this Position- Provides daily and/or project direction to appropriate staff identified.
Physical Demands- The physical activities of this position may include climbing, pushing, standing, hearing, walking, reaching, grasping, kneeling, stooping, and repetitive motion.
- Must have good balance and coordination.
- The physical requirements of this position are: light work - exerting up to 25 lbs. of force occasionally and/or up to 10 lbs. of force frequently.
- The Associate is required to have close visual acuity to perform an activity, such as preparing and analyzing data and figures; transcribing; viewing a computer terminal; or extensive reading.
- The conditions to which the Associate will be subject in this position: The Associate is not substantially exposed to adverse environmental conditions; job functions are typically performed under conditions such as those found in general office or administrative work
