Job Type

Full-time

Description

The Sr. General Counsel serves as the company's principal legal advisor and a key member of the Executive Committee, providing strategic and practical legal guidance across the organization. This role is responsible for helping the company navigate the highly regulated pharmacy benefit management (PBM) and healthcare environment while balancing legal and regulatory requirements with business objectives, growth, client needs, and operational realities.

The Sr. General Counsel will provide leadership and counsel across PBM operations, healthcare and pharmacy regulation, commercial contracting, corporate governance, enterprise risk management, compliance, disputes, regulatory matters, and ESOP-related legal considerations.

The ideal candidate is a seasoned, business-minded attorney who brings strong legal judgment, hands-on execution, and meaningful experience in healthcare, pharmacy benefits, managed care, insurance, employee benefits, or PBM-related environments. Experience working with an ESOP or employee-owned organization is highly valued.

This role is designed for a practical legal leader who can identify and prioritize material risk, provide clear recommendations, and help the business move forward without unnecessary legal complexity or expense.

Requirements

Executive & Strategic Legal Leadership

• Serve as the company's principal legal advisor to the President/CEO and Executive Committee.
• Provide practical legal guidance on strategic initiatives, business decisions, growth opportunities, regulatory risk, and enterprise-level issues.
• Participate as an active memberof the Executive Committee and contribute legal and risk perspectives to organizational strategy and decision-making.
• Partner with executive and business leaders to balance legal and regulatory requirements with commercial objectives and operational realities.
• Identify emerging legal and regulatory risks and proactively develop strategies to address them.

PBM, Healthcare & Regulatory Counsel

• Advise leadership and business teams regarding federal and state laws and regulations affecting PBM operations and healthcare services.
• Provide legal guidance related to claims administration, formularies, pharmacy networks, pharmacy reimbursement, rebates, benefit programs, employer-sponsored health plans, and related PBM services.
• Advise on state PBM laws and requirements, including registration, reporting, transparency, network, reimbursement, rebate, spread pricing, and pass-through requirements.
• Provide counsel regarding CMS requirements and Medicare and Medicaid matters relevant to PBM, health plan, pharmacy, and managed care operations.
• Advise on ERISA, HIPAA, HITECH, privacy, data security, fraud and abuse, and other applicable healthcare regulatory requirements.
• Monitor legislative, regulatory, and enforcement developments and translate changes into clear, actionable recommendations for leadership and impacted business teams.
• Partner with Compliance, Operations, Clinical, Client Services, Sales, Finance, and other departments to ensure legal requirements are incorporated into business processes.

Commercial Contracting

• Draft, review, negotiate, and oversee key commercial agreements, including:
  • PBM services agreements (PSA)
  • Client and payor agreements
  • Pharmacy network agreements
  • Manufacturer rebate and service arrangements
  • Vendor and technology agreements
  • Data-sharing and data-use agreements
  • Business Associate Agreements
  • Confidentiality and Non-Disclosure Agreements
  • Other strategic and commercial agreements
• Establish contract standards, templates, playbooks, and approval processes that support efficient and consistent contracting.
• Identify material contractual risks and provide practical recommendations for mitigating those risks.
• Partner with Sales, Client Services, Operations, Finance, and other stakeholders to support client retention, RFPs, new business opportunities, and strategic initiatives.

Corporate Governance, ESOP & Enterprise Risk

• Provide legal counsel regarding corporate governance, board matters, policies, procedures, and organizational risk.
• Advise leadership regarding ESOP-related legal, governance, fiduciary, transaction, and compliance matters.
• Support appropriate governance practices and documentation as the organization continues to grow.
• Partner with executive leadership to identify, assess, prioritize, and mitigate enterprise legal and business risks.
• Support internal investigations and other sensitive organizational matters requiring legal oversight.

Disputes, Audits & Regulatory Matters

• Manage litigation, disputes, regulatory inquiries, audits, investigations, and other legal matters.
• Coordinate and oversee outside counsel when specialized expertise is required.
• Establish appropriate strategies, budgets, and expectations for outside legal engagements.
• Manage outside counsel efficiently and cost-effectively while ensuring the company receives appropriate legal support.
• Serve as a key internal resource during regulatory examinations, governmental inquiries, significant audits, and other high-risk matters.

Legal Operations & Process Development

• Build and maintain scalable legal processes appropriate for a growing PBM organization.
• Develop and maintain legal templates, contracting playbooks, policies, procedures, approval workflows, and other resources.
• Establish appropriate processes for identifying when legal review is required and ensuring matters are escalated appropriately.
• Help business leaders understand legal requirements and risk without unnecessarily slowing business operations.
• Develop relationships and processes that allow the organization to resolve routine legal matters efficiently while reserving outside counsel for matters requiring specialized expertise.

Leadership & Partnership

• Build trusted relationships with executive leaders and business partners throughout the organization.
• Communicate complex legal issues in a clear, concise, and business-oriented manner.
• Educate leaders and team members regarding relevant legal, regulatory, compliance, privacy, and risk considerations.
• Promote a culture of proactive risk management, accountability, integrity, and sound business judgment.
• Serve as a steady and trusted advisor during periods of organizational growth, regulatory change, and business transformation.

Required Qualifications

• Juris Doctor (J.D.) degree from an accredited law school.
• Active license to practice law in at least one U.S. jurisdiction and in good standing with applicable bar authorities.
• Minimum of 15 years of legal experience, with meaningful experience in healthcare, PBM, pharmacy benefits, managed care, insurance, employee benefits, health plan administration, pharmaceutical services, or another closely related regulated industry.
• Significant experience advising senior executives and business leaders on complex legal and regulatory matters.
• Demonstrated experience with healthcare and/or pharmacy-related regulatory requirements.
• Experience with CMS, Medicare, and Medicaid matters related to pharmacy benefit management, health plan, pharmacy, or managed care operations.
• Strong contract drafting, negotiation, issue-spotting, and risk-prioritization skills.
• Demonstrated ability to exercise sound legal judgment while considering commercial and operational realities.
• Ability to independently manage a broad legal portfolio while effectively partnering across a growing organization.
• Experience managing outside counsel and controlling legal spending.
• High level of integrity, discretion, professionalism, and judgment when handling confidential and sensitive information.
• Willingness and ability to travel to the Washington, Indiana corporate office at least five business days per month and attend required in-person Executive Committee meetings.