Attorney Managed Care and Pharmacy

Title: Attorney Managed Care & Pharmacy

Job Description:

Job Order ID :

WI3888431

# of Positions :

1

Experience Required :

Duration :

Shift :

First Shift (Day)

Hours per week:

32

Job Description

JOB REQUIREMENTS: Discover. Achieve. Succeed. #BeHere Location:
US:WI:MENOMONEE FALLS at our CP-TOWN HALL HEALTH CENTER or NEENAH at our
THEDACARE CORPORATE OFFICES or WAUWATOSA at our FROEDTERT HOSPITAL. This
job is HYBRID. Mixture of remote and in-office including being on site
as needed. Residency in the State of Wisconsin within driving proximity
of office locations in Milwaukee County and Outagamie County, Wisconsin
required. FTE: 1.000000 Shift: Shift 1 Froedtert ThedaCare health (FTCH)
is a \6 Billion, integrated non-profit health care system that employs
over 25,000 people and treats 43% of the population of the state of
Wisconsin. FTCH has a large, academic medical center in partnership with
the Medical College of Wisconsin and a wholly owned health plan. It is
proud to serve its communities with Level 1 and 2 Trauma Centers,
critical access and community hospitals, multi-disciplinary clinics, and
a comprehensive offering of post-acute services. FTCH expects excellence
and consistently achieves top decile quality performance. This is your
chance to be part of a dynamic, innovative in-house team in an
organization that is transforming healthcare in Wisconsin. Job Summary:
Reporting to the Vice President, General Counsel (Corporate), primary
legal support for the 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). Works
closely with and serves as the legal business partner for internal
contract stakeholders and other organization leaders in support of the
MCOs and pharmacy business, consistent with FTCH mission, vision, and
enterprise values. Responsible for dispute resolution, litigation, and
arbitrations in areas of focus, and ensuring compliance with managed
care and pharmaceutical regulations, including 340B regulations, STARK
and anti-kickback statutes. Additional responsibilities include
providing 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 FTCH mission, vision, and enterprise values,
including dispute resolution related thereto. Provide legal guidance and
risk management counseling and retain and manage outside counsel as
needed within defined budges, in areas of responsibility. Be an integral
part, and advance the leadership, oversight, and efficiency, of the FTCH
Office of General Counsel (OGC) contracting team tasked with
interpreting, drafting, reviewing and negotiating contracts, including
mentoring, performance management, and ensuring delivery of high-quality
contracting team-related legal services. EXPERIENCE DESCRIPTION: 5-8
years of relevant contracting experience in a hospital or health system
setting, healthcare environment, or law firm that specializes in managed
care, pharmaceutical business, including 340B and pharmacy benefit
manager programs, with strong preference being the hospital or health
system setting. Experience negotiating terms and resolving disputes with
MCOs related to reimbursement rates, utilization management, prior
authorization procedures, network participation and challenging denials
of prior authorization requests for necessary medical treatments. Ensure
organizational compliance with all relevant laws, regulations, and
industry standards in managed care and pharmaceutical operations.
EDUCATION DESCRIPTION: Juris Doctorate (JD) from an accredited law
school is required. REGULATORY DESCRIPTION: Deep understanding of
federal and state laws governing managed care, including ERISA, HIPAA,
and Wisconsin-specific regulations is required.