Assistant General Counsel for Health Plan Operations

Job DescriptionA bit about this role: The Assistant General Counsel for Health Plan Operations serves as a key legal partner to Devoted’s health plan operations, providing practical, business-minded counsel across the full range of activities that keep our Medicare Advantage and related products running. This individual-contributor role reports to the Deputy General Counsel and supports claims, network development and management, provider contracting, delegated entity oversight, and regulatory compliance, translating a complex and evolving legal landscape into actionable guidance for business and clinical teams.The successful candidate combines strong health care regulatory knowledge with sharp business acumen, thrives in a fast-moving environment, and builds trusted, collaborative relationships across the organization. This is a hands-on advisory role for an attorney who enjoys solving operational problems, moving with urgency, and having a direct impact on how care is delivered to our members.Your Responsibilities and Impact will include: Support the claims process, advising on claims adjudication, payment integrity, appeals, and related legal and regulatory requirements.Support the network development and management team and advise on provider contracting, provider relationships, credentialing, and related operational matters.Work with compliance to ensure adherence to state regulatory requirements, and advise on compliance with state and federal health care laws and regulations.Advise on delegation arrangements with third parties, including TPAs, PBMs, behavioral health vendors, and other delegated entities.Collaborate cross-functionally with internal teams to support delegated entity oversight programs, including compliance monitoring, remediation, and regulatory reporting obligations.Interpret new and evolving regulatory guidance and translate it into actionable recommendations for business and clinical teams.Support regulatory exams, audits, and inquiries from state departments of insurance and other regulatory agencies.Support the legally compliant implementation of clinical programs, quality initiatives, and utilization controls.Work closely with cross-functional team members and business leaders to review legal issues and the implications of potential business decisions and initiatives.Required skills and experience: Licensed to practice in at least one state, with eight to ten (8–10) years of experience, including a minimum of two to four (2–4) years of in-house experience.Prior in-house experience at a health plan.Knowledge of health care regulatory requirements applicable to health plan operations, including claims, provider contracting, delegation and delegated entity oversight, and state and federal health care laws and regulations.Exercise strong business acumen and the ability to analyze legal issues from a business perspective.Proven ability to follow through on complex issues, meet regulatory deadlines, proact...