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Carrot Peelers, Sales, Personality and Your Job Search
In-House
Legal Staff
Health Care
Min 2 yrs required
Resolution Specialist The candidate will serve as the liaison between their designated business unit and Prime’s Legal and Government Affairs departments. This position will be the point of contact for all legal matters within their business area and will be accountable for developing the appropriate record keeping methodologies to allow for timely and appropriate response to legal inquiries. Create, prepare, review, edit and manage legal documents including contracts, corporate records, correspondence, reports and presentations for the department as assigned. Respond to requests for documentation related to litigation, subpoenas, or any other third party requests for information. Work with key internal stakeholders to initiate Pharmacy terminations and maintain appeal guidelines to support company termination reviews; serve as secretary of Prime’s Pharmacy Termination Appeals Committee (PTAC), including but not limited to coordinating meetings, taking meeting minutes, and distributing materials; coordinate the review process and updating of Prime’s PTAC and Credentialing Committee Charters on an annual basis. Coordinate external meetings, documentation review and status reporting with pharmacy’s legal counsel as required; support internal litigation management efforts and maintain appropriate tracking information regarding potential pharmacy terminations and termination appeals; receive and prepare audit documentation supporting pharmacy termination appeals. Assist with reviewing regulations as assigned; assist in the review and/or maintenance of pharmacy network agreements. Identify, resolve, and/or escalate current or potential legal issues. Other duties as assigned. Must have High school diploma from an accredited school or equivalent GED. Paralegal Certificate or equivalent degree in Legal or Paralegal Studies is needed. Should have 2 years experience within Legal or Compliance related role. Employment as a Legal Assistant / Paralegal for PBM or healthcare company or law firm advising a healthcare company is preferred. Must have experience with Excel, PowerPoint, Word, Access. Familiarity with contract terms and a thorough understanding of the contract negotiation process are preferred. Familiarity with Medicare Part D and Medicaid is desired.
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