Attorney Managed Care & Pharmacy

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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.

Flexible work arrangements available, with preference for hybrid (work and home office) schedule but must live in or be willing to relocate to the State of Wisconsin and be within driving proximity of office locations in Greater Milwaukee and Fox Valley areas.

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.

SPECIAL SKILLS DESCRIPTION :

Strong leadership communication and management skills. Strong project management skills. Excellent legal research and writing skills. Strong attention to detail. Ability to work independently and as part of a team. Effective communication and interpersonal skills. Proficiency in legal software and Microsoft Office Suite. Commitment, value, excellence, and professional development.

LICENSURE DESCRIPTION :

Licensed to practice law as in-house counsel and in good standing in the State of Wisconsin or be eligible to seek admission to practice in Wisconsin upon hire is required.

Perks & Benefits at Froedtert Health

Froedtert Health Offers a variety of perks & benefits to staff, depending on your role you may be eligible for the following :

• Paid time off
• Growth opportunity- Career Pathways & Career Tuition Assistance, CEU opportunities
• Academic Partnership with the Medical College of Wisconsin
• Referral bonuses
• Retirement plan - 403b
• Medical, Dental, Vision, Life Insurance, Short & Long Term Disability, Free Workplace Clinics
• Employee Assistance Programs, Adoption Assistance, Healthy Contributions, Care@Work, Moving Assistance, Discounts on gym memberships, travel and other work life benefits available

The Froedtert & the Medical College of Wisconsin regional health network is a partnership between Froedtert Health and the Medical College of Wisconsin supporting a shared mission of patient care, innovation, medical research and education. Our health network operates eastern Wisconsin's only academic medical center and adult Level I Trauma center engaged in thousands of clinical trials and studies. The Froedtert & MCW health network, which includes ten hospitals, nearly 2,000 physicians and more than 45 health centers and clinics draw patients from throughout the Midwest and the nation.

We are proud to be an Equal Opportunity Employer who values and maintains an environment that attracts, recruits, engages and retains a diverse workforce. We welcome protected veterans to share their priority consideration status with us at 262-439-1961. We maintain a drug-free workplace and perform pre-employment substance abuse testing. During your application and interview process, if you have a need that requires an accommodation, please contact us at 262-439-1961. We will attempt to fulfill all reasonable accommodation requests.