Legal Counsel Senior – PBM

Amerihealth
Published
July 17, 2021
Location
Philadelphia, PA
Category
Job Type

Description

Job Brief

Seeking 10+ years of experience in the legal field. A focus on health care regulatory law in a sophisticated complex environment is preferred within PBM, Medicaid and/or Medicare.

Your career starts now. We’re looking for the next generation of health care leaders.

At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you.

Headquartered in Philadelphia, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at www.amerihealthcaritas.com.

Responsibilities:

This position is an in-house Counsel position that will assist in advancing the important business objectives of the company to support existing business operations, develop strategic partnerships in the pursuit of new business opportunities, build accessible, flexible health systems across the nation and help people get care, stay well, and build healthy communities through various healthcare legal advisory activities supporting Medicaid, Medicare and/or related business components.

The position will be primarily responsible for:

  • Serving as a subject matter expert in providing thoughtful and timely legal advice to various managed care business units on day-to-day healthcare legal, regulatory and operational requirements.
  • Identifying business and legal risks and working with the business to provide solutions that balance legal issues and business objectives. The ideal candidate will be a seasoned in-house practitioner with pharmacy benefits management (PBM) subject matter expertise, particularly within the Medicaid and/or Medicare managed care setting; and who will also have in-house experience supporting managed care products with an emphasis on Medicaid and/or Medicare managed care and federally-facilitated marketplace products. The position requires an ability to develop an understanding of the business and operational goals of assigned internal clients, proactively advise business partners on a wide variety of matters, and work collaboratively with other attorneys on matters related to legal and regulatory compliance.
  • Operating with a high degree of integrity, in alignment with company mission and culture.

Education & Experience:

  • 10+ years of experience in the legal field. A focus on health care regulatory law in a sophisticated complex environment is preferred.
  • Licensed to practice law in at least one state.
  • Subject matter expertise of healthcare laws and regulations, including expertise providing managed care legal advice to managed care organizations and/or providers, with a focus on PBM, Medicaid and/or Medicare preferred.
  • Contract drafting and negotiation skills, including provider and vendor contracts required.
  • Ability to advise various business units concerning healthcare and corporate issues, including statutory and regulatory compliance, litigation avoidance and corrective action.
  • Ability to supervise responses to state and federal requests, and attorney, provider and member complaints, including drafting responses and reviewing responses drafted by the business.
  • Demonstrated analytical skills and the ability to work both independently and collaboratively, provide leadership, influence organization behavior and create alignment across organizational lines.
  • Personal presence, credibility, and the professional demeanor necessary to interact with company management, regulatory bodies, and business units with persuasiveness and confidence.
  • Ready, willing and able to assist with new needs and comfortable with uncertainty and ambiguity.
  • Excellent written and verbal communication skills.
  • Demonstrated analytical skills and strong legal project management and facilitation skills.
  • Collaborative team player with an ability to effectively manage competing priorities.
  • Excellent judgment and the ability to prioritize and make difficult decisions quickly.
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