Description:
Who we are:A Industrys Only Value-Based PBM is the leading clinically-driven, customer-first PBM company that puts the pharmacist at the center of its service model to optimize member care while substantially reducing costs for plan sponsors.
What we do:
We place more emphasis on member care than any other PBM by focusing on health outcomes first. Our pharmacists and clinicians are at the center of everything we do?and our population health solution delivers tailored strategies for our clients.
Who We're Looking for:
A Industrys Only Value-Based PBM is experiencing unprecedented growth, and we're seeking to add a Legal Counsel (Health Care Regulatory) to our team. Legal Counsel will partner with the General Counsel and business stakeholders on all regulatory and compliance matters, and other legal needs. Legal Counsel should have general health care and/or PBM experience and knowledge and is expected to understand and to apply federal laws and regulations such as HIPAA, ERISA, the ACA, and the CAA, and state laws and regulations pertaining to the licensing, reporting requirements, and operational requirements of PBMs and the privacy and security of patient information.
Legal Counsel supports business stakeholders in a wide range of activities including state licensing, contracting, applicability of regulation to operational needs including group plans (ERISA and non-ERISA), as well as instituting and managing compliance and risk mitigation strategies. Legal Counsel also provides legal support for other matters and duties as they arise and are assigned.
What You'll Do:
- Advise on various federal and state health regulatory issues, including regulations related to federal and state such as HIPAA, ERISA, the ACA, and state PBM laws and regulations, etc.
- Assist with interpreting and completing state licensure requirements, and reporting obligations for PBM, TPA and UR
- Negotiate, draft, evaluate and advise on contractual arrangements with entities in the healthcare space, including group health plans, healthcare providers, and other partners as needed.
- Review and negotiate BAA, NDA, Vendor agreements
- Update, provide and architect guidelines, training and compliance program in the areas of healthcare regulatory compliance such as HIPAA and other regulations pertaining to PBM
- Assist with privacy and HIPPA issues
- Handle fast paced and high-volume workload
- Identify legal and compliance issues and business risks and offer practical advice
- Work under the leadership of the General Counsel
What You Need:
- JD, admission to a state bar, 8+ years of healthcare regulatory experience at a combination of a top-tier law firm and in house companies (preferably high growth)
- Strong preference for candidates with PBM regulatory experience for ERISA plans
- Creative problem-solver, comfortable with ambiguity, complexity, and nuance.
- Excellent legal and business judgment
- Ability to translate complex legal issues and risks into understandable concepts the team and other individuals with non-legal backgrounds can execute on
- Thrive on being pushed and challenged. Ability to communicate effectively both in written form and verbally
- Willingness to learn new subject matters quickly and take on and drive projects from start to finish
Additional Qualifications:
- Solid interpersonal skills and Team player
- Highly motivated with the ability to support timely decisions
