General Counsel (MUST HAVE 10+ YEARS IN PBM OR ...

Job Summary The General Counsel provides leadership over all legal, regulatory, compliance, and governance matters related to the Company's operations. This role partners closely with the executive team and Board of Directors to manage risk, ensure regulatory compliance, and support the Company's growth and business objectives in a highly regulated environment. Key Responsibilities Regulatory & Compliance Oversight • Oversee compliance with federal and state healthcare laws and regulations applicable to PBMs, including ERISA, HIPAA/HITECH, state PBM, insurance, and pharmacy laws, Anti-Kickback Statute, and False Claims Act. • Monitor regulatory developments impacting PBMs and proactively advise leadership on risk mitigation and business impact. • Lead regulatory responses, audits, examinations, and enforcement matters. • Maintain an effective compliance program aligned with industry best practices. Legal Leadership & Governance • Lead and oversee the Company's legal and compliance functions, including policy development, training, and internal investigations. • Partner with executive leadership and the Board of Directors on governance matters and enterprise risk management. • Provide strategic legal counsel to support company growth and operational objectives. Contracts & Commercial Support • Oversee drafting, review, and negotiation of complex contracts, including: • Client and payor agreements • Pharmacy network and specialty pharmacy agreements • Manufacturer rebate and services agreements • Vendor and technology agreements • Support sales and business development efforts by advising on contract structure and regulatory considerations. Data Privacy & Information Security • Advise on data privacy, cybersecurity, and information governance matters involving protected health information (PHI). Litigation & Dispute Management • Manage all litigation, disputes, and government inquiries. • Coordinate with outside counsel as needed. Qualifications • Juris Doctor (JD) from an accredited law school. • Active license to practice law in at least one U.S. jurisdiction. • 10+ years of legal experience, with significant experience in healthcare, PBM, managed care, or health insurance. • Prior experience as in-house counsel or General Counsel in a PBM, health plan, healthcare services organization, or similarly regulated industry strongly preferred. • Demonstrated experience advising executive leadership and Boards of Directors. • Deep understanding of PBM operations and healthcare regulatory frameworks. • Strong executive presence with the ability to influence and advise at the highest organizational levels. • Exceptional judgment and ability to balance legal risk with business strategy. • Excellent leadership, communication, and negotiation skills. • Ability to manage complex, high-risk matters in a fast-paced regulatory environment.

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