Sr. Legal Counsel, Provider Networks - West Lead

Job DescriptionThe Sr. Legal Counsel will lead legal support services for the Western half of the United States, on matters involving Aetna's participating provider networks and other health care provider related matters. You will counsel our Provider Network Services business teams with respect to a wide range of health care provider matters including, but not limited to: complex provider contract negotiations for Commercial, Medicare, Medicaid and Specialty lines of business; development and negotiation of value-based arrangements; pre-arbitration/litigation dispute resolution; credentialing, regulatory and risk management support; and general legal support for both participating provider networks and out of network providers in your assigned region. This position will manage a team of two - three attorneys who will be assigned to specific states and/or subject matter areas relating to provider network support. You will report to the Vice President, Legal Services who is responsible for overseeing legal support for Aetna's provider network, clinical and claims operations. You will collaborate closely with the Provider Network Senior Counsel responsible for the Eastern half of the country (East Lead). Tasks include, but are not limited to the following, as they pertain to provider relationships in the Western half of the United States: advising the business with respect to significant regulatory matters involving provider network and out of network health care provider issues; advising the business on mitigating legal risks related to provider network relationships; overseeing team of 2-3 attorneys who provide provider contracting support, including support of complex provider health care system negotiations and value-based/risk arrangements; serving as subject matter expert for Legal colleagues throughout the CVS Health enterprise, on provider relationships in your region; supporting the VP Legal Services and your Eastern Lead counterpart in the development of legal strategy, templates and policies for Aetna's networks; working with the business and internal and external counsel to resolve provider disputes prior to arbitration/litigation; collaborating with the business on the development and review of sensitive, high level internal and external communications to various stakeholders (senior executives, regulators, lawmakers, advocates, members); providing counsel regarding new and revised coding practices and programs and their implications for participating and out of network providers; collaborating with Medicare and Medicaid counsel to implement federal and state specific legal research involving provider network services for government lines of business; serving as specific subject matter expert for assigned areas related to health care provider issues; providing day to day risk management support for internal business clients responsible for provider networks The attorney in this role will be expected to provide proactive risk management support and to assist in identifying and tracking related policies and practices. You will identify business and legal risks and provide solutions that balance legal issues and business objectives. You will be expected to develop a keen understanding of various operational systems and internal governance and to work diligently to develop and maintain positive relationships with various senior clients. You will be responsible for managing 2-3 attorneys responsible for the states in the Western half of the U.S.Required Qualifications 15+ years legal experience Experience with provider contracting, regulatory and related issues focusing on the State of California required Demonstrated business judgment and acumen required; Superior oral and written communication skills required; High level of interpersonal skills and ability to manage multiple responsibilities required; Ability to manage a team of 2-3 attorneys requiredCOVID RequirementsCOVID-19 Vaccination RequirementCVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work.Preferred Qualifications Experience with provider contracting and related issues in the State of Washington and Arizona preferred Knowledge of California and Washington healthcare system landscapeEducation Juris DoctorBusiness OverviewBring your heart to CVS HealthEvery one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver.Our Heart At Work Behaviors support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

Created: 2025-11-15