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Network Counsel
| Company | CVS Health |
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| Location | Hartford, CT, USA |
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| Salary | $144200 – $288400 |
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| Type | Full-Time |
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| Degrees | JD |
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| Experience Level | Senior |
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Requirements
- Juris Doctor from ABA-accredited institution required; Bar admission in good standing.
- 5+ years of legal experience.
- 3+ years of law firm, legal healthcare provider system, or government healthcare experience.
- 2+ years of provider or healthcare contracting experience.
Responsibilities
- Provide network contract and negotiation support as requested;
- Provide MLR, PIP and other regulatory expertise as it relates to the development of new templates or the negotiation of current templates;
- Coordinate with appropriate internal resources on any new or updated PADU language;
- Draft new templates in response to business need;
- Assist with negotiation of provider agreements.
- Advise clients with respect to various member/provider demand letters and assist, as requested, with pre-arbitration/litigation dispute resolution;
- Support business in its efforts to track and trend disputes for proactive dispute/litigation prevention;
- Review and advise on legal issues associated with contract terminations.
- In concert with RC and APC, advise clients with respect to the application of various state and federal laws and regulations including but not limited to ERISA, MHPAEA, fraud and abuse, and federal and state surprise billing and transparency laws and regulations;
- Assist with various regulatory filings, as needed;
- Assist in the coordination of answers to regulatory questions related to provider networks;
- May provide pharmacy research as needed;
- Work collaboratively with RC and APC, Compliance, Government Affairs and business operations teams to implement new laws and regulations;
- Provide legal review for select communications;
- Perform state specific research relating to issues raised while supporting network and pharmacy functions as requested.
- Provide guidance related to new products/initiatives/service area expansions;
- Assist with review and comment on proposed and new regulations applicable to the scope of counsel provided to the business.
Preferred Qualifications
- Experience with Medicare and/or Medicaid regulatory landscape preferred;
- MLR familiarity and experience preferred;
- Litigation or other experience assisting with member and provider disputes preferred;
- Experience working with state regulators and/or responding to state inquiries and exams preferred;
- Knowledge of accreditation requirements—specifically NCQA preferred;
- Knowledge of federal health care laws, including surprise billing, transparency and/or mental health parity preferred;
- At least 2 years experience in a law firm health care practice; or in-house experience at a managed care company; or governmental experience preferred.
- Demonstrated business judgment and acumen required;
- Superior oral and written communication skills required;
- High level of interpersonal skills and ability to manage multiple responsibilities required.
- Familiarity with healthcare regulations.
- Pharmacy or PBM experience.
