Senior Counsel - Pharmacy Solutions

San Antonio, Texas, United States

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Not SpecifiedCompensation

Senior (5 to 8 years), Expert & Leadership (9+ years)Experience Level

Full TimeJob Type

UnknownVisa

Healthcare, Pharmacy Benefit ManagementIndustries

Requirements

Candidates must possess a Juris Doctorate degree from an ABA accredited law school and have 6+ years of legal experience in the health care industry. An active state bar association membership, strong contract drafting and analytical skills, and the ability to work independently and in teams are required. Deep expertise in negotiating PBM contracts and knowledge of pharmacy laws and the pharmaceutical supply chain are preferred.

Responsibilities

The Senior Counsel will provide legal support for strategic initiatives, including contract negotiations with pharmaceutical manufacturers and ERISA self-funded employee welfare benefit plans. They will offer legal guidance on federal and state regulatory compliance, advise on risk exposure and mitigation strategies, and monitor legislative and regulatory changes. This role also involves supporting audits, investigations, and responses to regulatory inquiries related to PBM and pharmacy services.

Skills

PBM

Pharmacy Operations

Contract Drafting

Contract Negotiation

Contract Management

Regulatory Compliance

Risk Management

ERISA

Pharmaceutical Manufacturers

Pharmacy Laws

Pharmaceutical Supply Chain

Legal Research

Legal Analysis

Humana

Health insurance provider for seniors and military

About Humana

Humana provides health and well-being services, focusing on Medicare Advantage plans for seniors, military personnel, and communities. Their plans include HMO, PPO, and PFFS options, designed to improve health outcomes through comprehensive and flexible coverage. Humana's revenue comes from government contracts and member premiums, and they aim to maintain high renewal rates by offering quality service and competitive benefits. The company stands out by fostering a culture of inclusivity and belonging among its employees, while also ensuring accessibility for all members, including offering free language interpreter services. Humana's goal is to deliver value to its members through an extensive provider network and innovative health solutions.

Louisville, KentuckyHeadquarters

1961Year Founded

IPOCompany Stage

Social Impact, HealthcareIndustries

10,001+Employees

Risks

Potential over-reliance on AI could disrupt operations if systems fail or are compromised.

Rising medical costs and tightening Medicare reimbursements may strain financial performance.

Leadership change with new CEO Jim Rechtin could lead to strategic disruptions.

Differentiation

Humana is a leader in Medicare Advantage plans, focusing on seniors and military personnel.

The company emphasizes inclusivity, offering free language interpreter services for accessibility.

Humana leverages AI and cloud technologies through a partnership with Google Cloud.

Upsides

Humana's investment in Healthpilot enhances digital enrollment for Medicare options.

The company is the first insurer to cover TMS therapy for adolescent depression.

Humana's focus on value-based care aims to improve outcomes for kidney disease patients.

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