Why work at Presbyterian? As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans. For our employees, we offer a robust wellness program, including free access to our on-site and community-based gyms, nutrition coaching and classes, wellness challenges and more.
Presbyterian's story is really the story of the remarkable people who choose to work here. The hard work of our physicians, nurses, employees, board members and volunteers grew Presbyterian from a tiny tuberculosis sanatorium to a statewide healthcare system that serves more than 875,000 New Mexicans.
Reporting to the PHP Associate General Counsel, this in-house counsel position is responsible for providing legal advice and services to Presbyterian Health Plan (PHP). This position is the Court Liaison under the Medicaid Turquoise Care contract and is responsible for being the single point of contact for court system stakeholders to ensure member care coordination related to court orders and case dispositions, and for coordination of civil commitments and communication of court-related follow-up.
Working with moderate to little supervision, this position is also responsible for providing accurate, relevant and timely legal advice to PHP business units on a variety of health plan legal and regulatory topics; gathers evidence and information for management decision making; prepares, reviews and negotiates legal documents and agreements; provides advice and analysis of healthcare laws and regulations.
Juris Doctor degree from an accredited law school and active license to practice law in New Mexico, or the ability to become licensed in New Mexico, and a member in good standing of the New Mexico state bar. Reside in New Mexico 3-5 years of experience practicing law Preferred experience in the health law field, with a focus on healthcare regulatory compliance, contracting and transactions, and knowledge of the New Mexico court system Strong written and verbal communication skills Ability to maintain strong professional relationships across the company Ability to communicate legal issues and risk in terms that business clients understand Self-starter with the ability to work in a fast-paced legal practice and business environment Microsoft Office Skills Legal Role Responsibilities:
Provide legal advice to business stakeholders to identify and mitigate legal, regulatory, and business risk in proposed business transactions Draft, review, revise and negotiate vendor and other commercial contracts and agreements Work with the appropriate business clients and other attorneys to resolve claims, contract disputes and threatened claims from vendors, providers and health plan members, including providing legal advice Provide legal support to the PHP Appeals & Grievances department on member and provider disputes, including managing Medicaid Fair Hearings, Medicare administrative law judge, and Commercial OSI hearing processes Provide support for contracting matters and provider-related disputes. Provide support to litigation team in defending health plan-related disputes, lawsuits and subpoenas Conduct legal research and monitor and stay current with changes in legislation at the state and federal level affecting health care operations. Provide education, training, and guidance in formal and informal settings on a regular basis to identify and mitigate legal risk across PHP and assist PHP business and operations teams with maintaining compliance with healthcare laws and regulations Provide backup coverage for other department attorneys and participate in the call rotation for after-hours legal emergencies
Turquoise Care Court Liaison Role Responsibilities: Single point of contact for court system stakeholders (e.g., state, federal, county, municipal, and tribal courts) Work with the member care coordination team to ensure members receive care coordination related to any court orders and case dispositions Coordinate all civil commitments and communication of court-related follow-up and requirements to appropriate staff Work with the member care coordination team to help ensure providers are adhering to the treatment requirements assigned through court-ordered treatment
Other Responsibilities: Work as a legal generalist with interest and willingness to take on and manage additional areas of responsibility over time Develop strong relationships with business partners and stakeholders Function as an effective team member with the ability to work in a matrix environment Perform other functions as required
We offer more than the standard benefits!
Presbyterian employees gain access to a robust wellness program, including free access to our on-site and community-based gyms, nutrition coaching and classes, wellness challenges and more!
Learn more about our employee benefits:
About Presbyterian Healthcare Services
Presbyterian Healthcare Services exists to improve the health of patients, members and the communities we serve. We are a locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1,600 providers and nearly 4,700 nurses.
Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.
About Our Regional Delivery System
Presbyterian's Regional Delivery System is a network of six hospitals and medical centers throughout rural New Mexico including locations in Clovis, Espanola, Ruidoso, Santa Fe, Socorro and Tucumcari. Our regional facilities are home to more than 1,600 clinical and non-clinical employees who help make Presbyterian the state's largest private employer with nearly 14,000 statewide employees. With a variety of services ranging from general surgery to pediatrics to heart and cancer care, our regional employees are proud to provide close-to-home care for their communities.
We are part of New Mexico's history - and committed to its future. That is why we will continue to work just as hard and care just as deeply to serve New Mexico for years to come.
About New Mexico
New Mexico continues to grow steadily in population and features a low cost-of living.
Varied landscapes bring filmmakers here from around the world to capture a slice of the natural beauty New Mexicans enjoy every day. Our landscapes are as diverse as our culture - from mountains, forests, canyons, and lakes, to caverns, hot springs and sand dunes.
New Mexico offers endless recreational opportunities to explore and enjoy an active lifestyle. Venture off the beaten path, challenge your body in the elements, or open yourself up to the expansive sky. From hiking, golfing and biking to skiing, snowboarding and boating, it's all available among our beautiful wonders of the west.
AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.
USD $55.26/Hr.
The compensation range for this role takes into account a wide range of factors, including but not limited to experience and training, internal equity, and other business and organizational needs.
