Associate Counsel – Pharmacy Benefit Management

🔥 12 hours ago

🏈 Alabama, Arizona, +21 more states – Remote

🏈 Alabama – Remote 🌵 Arizona – Remote 🐊 Florida – Remote 🥔 Idaho – Remote 🌾 Iowa – Remote 🌪️ Kansas – Remote 🐎 Kentucky – Remote ⚜️ Louisiana – Remote 🌲 North Carolina – Remote 🏈 Ohio – Remote 🌪️ Oklahoma – Remote 🚗 Michigan – Remote 🎸 Mississippi – Remote 🏰 Missouri – Remote 🔔 Pennsylvania – Remote 🌴 South Carolina – Remote 🗿 South Dakota – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⛷️ Utah – Remote ⚔️ Virginia – Remote 🧀 Wisconsin – Remote 🦬 Wyoming – Remote

💵 $130.6k - $208.9k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

⚖️ Legal Counsel / General Counsel

👻 Ghost score 0%

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Blue Cross NC

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

Founded 1933

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

Blue Cross NC is a health insurance provider that offers a range of health plans and services to individuals and groups. The company focuses on delivering quality healthcare coverage and improving health outcomes for its members through innovative health programs and services. Blue Cross NC is committed to enhancing access to affordable healthcare while supporting the health and wellness of the communities it serves.

📋 Description

• Provide legal support for Blue Cross NC’s Pharmacy Benefit Manager services, including services provided to the North Carolina State Health Plan • Develop and maintain working knowledge of PBM contracts and related legal requirements • Review PBM materials, communications, program documents, policy updates, vendor submissions, and other work product • Advise business partners on PBM contractual requirements related to pharmacy administration, claims processing, formulary support, rebates, pricing, reporting, member communications, audits, and vendor performance • Serve as legal counsel supporting the PBM business and administration of the State Health Plan PBM contract • Advise on federal and state legal and regulatory requirements affecting pharmacy benefits and health plan administration • Support pharmacy benefit initiatives, benefit changes, vendor integrations, member communications, reporting processes, and operational workflows • Advise on privacy, security, data governance, confidentiality, and information-sharing requirements • Support responses to audits, investigations, administrative inquiries, regulatory requests, compliance reviews, and information requests • Assist with public records requests and confidentiality analyses • Monitor legal, regulatory, legislative, and market developments and communicate implications to stakeholders • Provide legal support for member complaints, appeals, grievances, claims administration issues, pharmacy network issues, benefit interpretation, and vendor disputes • Develop and deliver training on legal, regulatory, contractual, and compliance topics • Provide support on developing legal issues and perform other duties as assigned

🎯 Requirements

• Graduate of an accredited law school required • 3+ years of experience in related field • Licensed to practice law • Experience supporting pharmacy benefit management, pharmacy benefits, health plan administration, self-funded health plans, government-sponsored health programs, or large employer group health plans • Experience advising on PBM contracts, pharmacy benefit administration, rebate arrangements, formulary matters, pharmacy networks, specialty pharmacy, claims administration, or vendor oversight • Familiarity with Chapter 135 of the North Carolina General Statutes, the North Carolina State Health Plan, public procurement, government contracting, and public records laws • Experience assessing insurance regulatory requirements for governmental or self-funded health plan arrangements • Experience advising on federal requirements impacting health plans, pharmacy benefits, privacy, data use, transparency, claims administration, or vendor management • Experience reviewing and interpreting complex service agreements, performance guarantees, implementation requirements, reporting obligations, financial terms, and audit provisions • Strong issue-spotting ability and demonstrated judgment • Ability to provide timely, practical, legally supportable feedback • Ability to translate complex legal and contractual requirements into clear, actionable guidance • Excellent written and oral communication skills • Collaborative approach to client service, vendor oversight, and relationship management • Intellectual curiosity, adaptability, sound judgment, and a strong learning mindset

🏖️ Benefits

• Work-life balance, flexibility, and autonomy • Medical, dental, and vision coverage • Health and wellness programs • Parental leave and support • Adoption and surrogacy assistance • Career development programs • Tuition reimbursement for continued education • 401k match including an annual company contribution • Annual Incentive Bonus • Paid Time Off (PTO)