Associate General Counsel (Regulatory and Commercial)

Overview:

The Associate General Counsel will serve in a hybrid healthcare regulatory and commercial role, providing strategic legal counsel on healthcare laws and regulations, data privacy, Medicare and Medicaid compliance and related regulatory matters, while also supporting a broad range of commercial contracting activities. The role supports business lines spanning health plans and other payers, healthcare providers, specialty pharmacy and life sciences, including quality measurement and risk adjustment analytics. The role will draft, review, and negotiate a broad range of commercial agreements, including customer and vendor contracts. Working closely with business leaders, the Associate General Counsel will advise on matters involving healthcare analytics, artificial intelligence ("AI"), software-as-a-service ("SaaS") and data strategy. The Associate General Counsel will also have significant interaction with internal clients and senior executives, as well as extensive cross-functional collaboration with all functions that touch the sales cycle.

Responsibilities

• Provide legal and strategic advice and counsel on a variety of matters with a focus on healthcare regulatory compliance, commercial contracts and various other corporate transactions;

• Advise business teams on the legal and regulatory considerations associated with commercial transactions, including matters involving the Anti-Kickback Statute, False Claims Act, and related healthcare fraud and abuse laws;

• Draft and negotiate a broad range of complex commercial agreements, identify and resolve material legal and business issues, and develop practical contractual solutions;

• Advise on business proposals, commercial arrangements, and go-to-market strategies, structuring practical solutions that advance business objectives while managing healthcare regulatory and contractual risk;

• Advise on products and services supporting Medicare Advantage, ACA, and Medicaid risk adjustment programs, including RADV audits, chart review, supplemental data submissions, provider engagement, and related fraud, waste, and abuse risks;

• Serve as a subject-matter resource on HIPAA, HITECH and applicable state privacy and laws, negotiate and interpret business associate agreements, subcontractor BAAs, data use agreements and advise on permitted uses and disclosures of PHI;

• Review and recommend approaches to resolve the privacy aspects of vendor and customer contracts and other commercial transactions;

• Advise on de-identification and limited data sets under the HIPAA Expert Determination and Safe Harbor methods, re-identification risk, tokenization and data-linking arrangements, and downstream commercialization rights in de-identified and aggregated data;

• Advise health systems, medical groups, ambulatory facilities, and hospitals on clinical data access, EHR integration and interoperability, provider incentive and engagement programs, information blocking, and 21st Century Cures Act requirements;

• Support the specialty pharmacy business, including hub services, patient support and adherence programs, manufacturer, pharmacy and payer arrangements, copay and patient assistance considerations, and applicable state pharmacy and PBM regulation;

• Support AI governance: responsible AI, model and training-data rights, algorithmic transparency in clinical and quality use cases, and emerging AI regulation affecting healthcare analytics;

• Support the Legal Department's broader business objectives by handling non-commercial legal matters as needed. This could include, but not be limited to: pre-litigation matters, dispute resolution, customer correspondence, regulatory inquiries, subpoenas and other legal initiatives depending on capacity and workload;

• Contribute to legal department process improvement, playbooks, templates and contract-lifecycle tooling;

• Take on additional assignments and responsibilities as business needs dictate;

• Maintain compliance with Inovalon’s policies, procedures and mission statement;

• Adhere to all confidentiality and HIPAA requirements as outlined within Inovalon’s Operating Policies and Procedures in all ways and at all times with respect to any aspect of the data handled or services rendered in the undertaking of the position;

• Fulfill those responsibilities and/or duties that may be reasonably provided by Inovalon for the purpose of achieving operational and financial success of the Company; and

• We reserve the right to change this job description from time to time as business needs dictate and will provide notice of such.

Qualifications

• Minimum of 12 years of legal experience with at least five (5) years of specialized healthcare experience working at a law firm, corporate legal department, federal healthcare agency or similar environment;

• Significant experience with health care regulatory and transactional matters;

• Demonstrated working knowledge of HIPAA, Business Associate Agreements and de-identification of health data;

• Familiarity with payer operations and CMS programs, including risk adjustment and quality measurement (e.g., HEDIS, Star Ratings), and with provider-facing data and interoperability arrangements;

• Exposure to specialty pharmacy, hub services or pharmacy/PBM regulation is a plus;

• Substantial experience with commercial contracting, including drafting, reviewing, negotiating and advising business partners on complex agreements;

• Ability to provide strategic regulatory advice and effectively communicate with senior management on complex legal issues;

• Ability to distill and clearly communicate legal and regulatory concepts in concise, plain language to Sales, Product and other business leaders in support of advancing corporate goals and objectives;

• Exceptional business judgment, with the ability to think tactically and strategically and provide practical advice by balancing business needs with legal risks;

• Ability to operate comfortably in a matrixed environment;

• Ability to independently manage, set priorities, execute effectively and pivot as appropriate and,

• History of being a team player and willingness to contribute wherever needed.

Education:

• J.D. degree from an accredited law school and licensed to practice law in any US state or Washington, D.C.

Physical Demands and Work Environment:

• Sedentary work (i.e., sitting for long periods of time) Exerting up to 10 pounds of force occasionally and/or negligible amount of force;

• Frequently or constantly lift, carry push, pull or otherwise move objects and repetitive motions;

• Subject to inside environmental conditions; and

• Travel for this position will include less than 10%.

This position is not eligible for immigration sponsorship (e.g. H-1B, TN, or E-3). Applicants must be authorized to work in the United States as a condition of employment. (This is only applicable for US-based positions)

If you don’t meet every qualification listed but are excited about our mission and the work described, we encourage you to apply. Inovalon is most interested in finding the best candidate for the job, and you may be just the right person for this or other roles.

By embracing inclusion, we enhance our work environment and drive business success. Inovalon strives to provide equal opportunities to the communities where we operate and to our clients and everyone whom we serve. We endeavor to create a culture of inclusion in which our associates feel empowered to bring their full, authentic selves to work and pursue their professional goals in an equitable setting. We understand that by fostering this type of culture, and welcoming different perspectives, we generate innovation and growth.

Inovalon is proud to be an equal opportunity workplace. We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender identity or veteran status. We also consider qualified applicants regardless of criminal histories, consistent with legal requirement.

To review the legal requirements, including all labor law posters, please visit this link

To review the California Consumer Privacy Statement: Disclosures for California Residents, please visit this link