Director/Senior Legal Counsel – Medicare, Healthcare Regulatory & Contracting
About The Position
We are seeking an experienced and business-oriented healthcare attorney to join our Legal team. This role will serve as a strategic legal advisor to senior leadership and business partners, providing legal support across Medicare Part D, healthcare regulatory compliance, contracting, and operational initiatives. The successful candidate will have deep experience with Medicare, health insurance and healthcare laws, substantial healthcare contracting expertise, and the ability to provide practical legal advice that balances regulatory requirements with business objectives. This attorney will play a key role in supporting a rapidly growing healthcare organization operating in a highly regulated environment.
Requirements
- Juris Doctor (J.D.) from an accredited law school.
- Active license and good standing in at least one U.S. state.
- 8+ years of legal experience in a law firm, healthcare organization, health plan, PBM, managed care organization, or combination thereof.
- Significant experience with Medicare Part D regulatory requirements.
- Extensive healthcare contracting experience, including complex commercial and vendor agreements.
- Strong knowledge of federal and state healthcare laws and regulations.
- Experience advising cross-functional business teams in a fast-paced environment.
- Excellent drafting, negotiation, analytical, and communication skills.
- Demonstrated ability to manage multiple priorities independently.
Nice To Haves
- Experience supporting Medicare Advantage plans, PBMs, health plans, TPAs, or managed care organizations.
- Experience with CMS audits, corrective action plans, and regulatory examinations.
- Knowledge of delegated entity and FDR oversight requirements.
- Experience with provider contracting and network management.
- Experience with healthcare technology, data privacy, and digital health products.
- Familiarity with Medicaid and commercial health plan regulations.
- Experience supporting mergers, acquisitions, and strategic healthcare transactions.
Responsibilities
- Provide legal advice regarding Medicare Part D, health insurance and other federal healthcare program requirements.
- Counsel business teams on CMS regulations, guidance, audits, reporting obligations, and regulatory enforcement matters.
- Monitor and interpret changes in healthcare laws and regulations and advise leadership regarding operational impacts.
- Support regulatory change management initiatives and implementation of new legal requirements.
- Advise on regulatory risks associated with business operations, products, and strategic initiatives.
- Assist with government audits, investigations, corrective action plans, and responses to regulatory inquiries.
- Draft, review, negotiate, and advise on a broad range of healthcare and commercial agreements, including: Rebate and delegation agreements, Client agreements, Network and managed care contracts.
- Develop contracting standards, templates, negotiation playbooks, and risk management processes.
- Partner with procurement, operations, compliance, and business teams to facilitate efficient contract review and execution.
- Support vendor selection, due diligence, onboarding, and ongoing oversight activities.
- Provide legal guidance on: False Claims Act, Anti-Kickback Statute, Stark Law, Medicare and Medicaid requirements, State insurance and healthcare regulations.
- Support compliance investigations, policy development, training initiatives, and operational audits.
- Provide practical, solution-oriented legal guidance aligned with business objectives.
- Identify legal risks and develop creative, operationally feasible solutions.
- Support corporate growth initiatives, product development, and strategic transactions as needed.
Benefits
- The range represents the low and high end of the anticipated base salary range. The actual base salary will depend on several factors such as: experience, knowledge, skills, and location of the job.
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What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
Ph.D. or professional degree
