Attorney, Managed Care (Pharmacy)

ThedaCare-posted 3 months ago
Full-time
Hybrid • Appleton, WI
Hospitals
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Responsible for the legal oversight, management, and administration of the drafting, review, and negotiation of all system contracts with managed care organizations (MCOs) and pharmaceutical-related entities, including 340B programs for Froedtert ThedaCare Health, Inc. (FTCH) internal contract stakeholders and other organization leaders, consistent with the FTCH mission, vision, and enterprise values, including dispute resolution, and compliance therewith to managed care regulations. Responsible for the legal oversight, management, and administration of the drafting, review, and negotiation of additional key transactions, as assigned, for FTCH internal contract stakeholders and other organization leaders, consistent with the FTCH mission, vision, and enterprise values, including dispute resolution related thereto.

  • Functions as lead attorney in the drafting, review and negotiations of critical/complex managed care, pharmacy and key transaction contracts.
  • Delivers legal advice and recommendations to FTCH internal contract stakeholders and other organization leaders.
  • Engages, works with and manages outside legal counsel as necessary.
  • Provides legal guidance on contractual obligations and risk management.
  • Ensures proper documentation and compliance with contractual terms.
  • Works closely with VP, General Counsel (Corporate Law) and other department support staff to improve processes and systems.
  • Ensures proper deployment of OGC contracting team resources.
  • Functions as lead attorney in the support and resolution of legal contractual disputes.
  • Supports FTCH on litigation and arbitrations arising from disputes with MCOs.
  • Ensures organizational compliance with all relevant laws, regulations, and industry standards.
  • Oversees and advises on internal policies and procedures related to managed care and provider contracts.
  • Monitors changes in pertinent legislation and regulations.
  • Collaborates with and supports internal team regarding company certification and audit programs.
  • Mentors, manages performance, and evaluates the OGC contracting team.
  • Maximizes use of and drives efficiencies in system's contract management software.
  • Juris Doctorate (JD) from an accredited law school.
  • Licensed to practice law as in-house counsel in the State of Wisconsin or eligible for admission.
  • Minimum of 4 years relevant contracting experience, with 5-8 years preferred.
  • Experience negotiating terms and resolving disputes with MCOs.
  • Deep understanding of federal and state laws governing managed care.
  • Strong leadership communication and management skills.
  • Strong project management skills.
  • Excellent legal research and writing skills.
  • Strong attention to detail.
  • Ability to work independently and as part of a team.
  • Effective communication and interpersonal skills.
  • Proficiency in legal software and Microsoft Office Suite.
  • Experience advising hospital or health group participation in pharmaceutical programs.
  • Experience with Public Health Service Act 340B Drug Pricing Programs.
  • Experience with group purchasing organizations (GPOs).
  • Experience establishing and operating a Pharmacy Benefit Manager program.
  • Lifestyle Engagement: health coaches, relaxation rooms, health focused apps, mental health support.
  • Access & Affordability: minimal or zero copays, team member cost sharing premiums, daycare.
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