Description:

Purpose:
The Corporate Counsel, PBM and Payer Contracting possesses deep expertise in the healthcare industry, particularly in pharmacy benefit management (PBM) strategy and contracts, payer contracting, and government healthcare programs such as Medicare and Medicaid. The Corporate Counsel has a strong understanding of the regulatory frameworks governing these areas, including CMS guidance, Medicaid Managed Care rules, and federal/state healthcare laws. This role requires a proactive legal professional who can serve as a strategic advisor to the business, ensuring compliance, managing risk, and supporting a wide range of legal needs across the organization.

Responsibilities:

Provides legal counsel on federal and state healthcare regulations impacting PBM operations, payer relationships, and government program participation (Medicare Part D, Medicaid Managed Care, etc.).
Advises on CMS guidelines, Medicaid regulations, and other applicable laws and advisory opinions.
Drafts, reviews, and negotiates contracts with PBMs, health plans, payers, and government entities.
Ensures contracts align with legal and regulatory requirements and support business objectives.
Supports vendor and service agreements as needed.
Collaborates with compliance and quality teams to ensure adherence to healthcare laws and accreditation standards.
Provides legal support for licensing and regulatory filings across jurisdictions.
Advises on employment-related legal matters, including labor law compliance, employee relations, and internal investigations.
Serves as a legal advisor to business leaders, offering strategic guidance on initiatives and risk mitigation.
Supports general operational matters.
Manages outside counsel for litigation, regulatory investigations, and third-party subpoenas; coordinates document production and discovery responses.
Partners with internal stakeholders across departments to support strategic initiatives and ensure legal alignment; demonstrate leadership and teamwork in a dynamic, fast-paced environment.
Performs additional responsibilities as assigned by the Chief Legal Officer.

Required Qualifications:

Juris Doctor (JD) from an accredited law school.
Minimum four (4) years of legal experience, preferably in PBM, payer contracting, or government healthcare programs.
Licensed attorney in good standing in at least one U.S. jurisdiction.
Strong knowledge of healthcare regulations, including CMS, Medicare/Medicaid, and payer contracting frameworks.
Proven experience negotiating contracts with PBMs, health plans, and government entities.
Excellent analytical, communication, and organizational skills.
Ability to manage multiple priorities independently and collaboratively.

Preferred Qualifications:
Experience with employment law, compliance, and litigation management

Work Environment:
This position operates in a home or professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets and fax machines.

Physical Demands:
While performing the duties of this job, the employee is regularly required to see, talk, or hear. The employee frequently is required to sit; stand; walk; use hands and fingers, handle or feel; and reach with hands and arms. Visual acuity is necessary for tasks such as reading, observing surroundings, or working with various forms of data. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions of the job.