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In-House
Attorney
Corporate - General
Health Care
Min 5 yrs required
Senior Legal Counsel, Pharmacy Benefit Management The candidate will be responsible for analyzing and interpreting federal and state laws and regulations relating to the company’s diverse pharmacy management business. Researching, reviewing/analyzing, and interpreting federal and state laws and regulations for applicability to the company’s pharmacy benefits products and services. Directly regulating pharmacy benefit management; laws impacting the structure of pharmacy benefits including ERISA and the Affordable Care Act; laws relating to management of retail pharmacy networks, including maximum allowable cost, audit bill of rights, any willing provider, and prompt pay laws; laws regulating utilization management activities; federal and state anti-kickback laws and fraud and abuse requirements; state pharmacy practice laws and regulations; and other areas as required. Collaborating with operational staff, compliance staff, and leadership to implement business practices and processes to ensure compliance with applicable laws and regulations. Interacting with internal and external customers and regulators concerning such matters, including reviewing and responding to regulatory inquiries. Conducting and/or assisting with training relating to legal and regulatory requirements. Reviewing policies, documents and correspondence (e.g., member, customer and provider communications), for adherence with statues and regulations. Must have JD degree and admitted to practice law in one state. Should have 5+ years of legal experience in healthcare industry. 8+ years of experience in a law firm, corporate or government setting practicing in a legal specialty area of relevance to the operations and functions and business is required. Excellent written and verbal communications/advocacy skills, ability to work independently, ability to fashion practical business solutions to complex legal situations, negotiation skills is needed. General knowledge of the behavioral health care industry and regulatory environment is must.
Ref: R00000019933
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