Managed health care is a highly regulated industry and the laws and regulations affecting Magellan’s operations are complex and change rapidly. This position is responsible for analyzing and interpreting federal and state laws and regulations relating to the company’s diverse pharmacy management business. The ideal candidate will have broad experience in the pharmacy benefit management business having focused significantly on a wide range regulatory issues arising in this context.
Researching, reviewing/analyzing, and interpreting federal and state laws and regulations for applicability to the company’s pharmacy benefits products and services.
Primary areas include, but are not limited to laws 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.
JD: Law (Required)
License and Certifications - Required
License and Certifications - Preferred
Other Job Requirements
Admitted to practice law in at least one state. Excellent written and verbal communications/advocacy skills, ability to work independently, ability to fashion practical business solutions to complex legal situations, negotiation skills. General knowledge of the behavioral health care industry and regulatory environment.
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 of Magellan.
Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled