• Provider Relationships: provide legal counsel with respect to provider contracting, provider disputes, and provider communications and policies.
• Pharmacy Service: provide legal counsel related to pharmacy benefits administration, contracting and oversight of pharmacy benefits manager (PBM) and specialty pharmacy providers.
• Vendor and IT Contracts: draft, review, revise and interpret vendor and IT contracts, and provide legal counsel as needed.
• Litigation: assist with litigation, including subpoenas, 93A demand responses, subrogation, provider audits, and class action recoveries, as needed.
• Confidentiality/Privacy: provide legal counsel with respect to federal and state confidentiality and privacy rules, including HIPAA.
• Marketing and Member Communications: provide legal counsel related to marketing and communications with members, including evidences of coverage and marketing materials.
• New Business Development: provide compliance advice with respect to new products and servicesRegulatory Compliance: interpret federal and state laws and regulations impacting BMCHP’s business, including but not limited to managed care laws, federal health reform, MassHealth, Connector Authority/QHP, New Hampshire Department of Health & Human Services, and Division of Insurance regulations, and provide related legal counsel to internal customers.
• Relationships: establish and maintain effective working relationships with internal customers, including members of the Executive Staff and Leadership Team, outside counsel, governmental representatives and regulators, and other third parties.
• Outside Counsel: establish and maintain effective working relationships with outside counsel and manage time and expenses associated with them.

• None

• General supervision is received on a weekly basis.

• Juris Doctor of Laws from a duly accredited law school required.
• Current Massachusetts Bar membership required.
• Minimum five (5) years of legal experience required.
• Ability to draft contracts and other legal documents, negotiate contracts and determine appropriateness of potential legal actions.
• Demonstrated research and writing skills.
• Ability to analyze legal problems and provide efficient and effective legal services and advice.
• Ability to identify, strategize, anticipate and respond to a broad range of issues related to business, operations and risk management.

Preferred:

• At least three (3) years legal experience in a health care, Medicaid, and/or managed care environment strongly preferred.
• Additional experience in litigation
• Familiarity with federal and state laws and regulations applicable to the managed care industry.
• Additional New England states bar memberships, including New Hampshire.

• Pre-employment background check

• Strong oral and written communications skills essential.
• Strong interpersonal skills and ability to communication effectively throughout all levels of the organization as well as with external parties essential.
• Strong collaborative skills essential to maintain an effective working relationship with corporate-wide contacts
• Excellent judgment – ability to assess risks and benefits.
• Ability to work with limited supervision or independently
• Attendance: regular and reliable attendance is an essential function of the position.

• Work is normally performed in a typical interior/office work environment.
• No or very limited physical effort required. No or very limited exposure to physical risk.

For more information , click  here.