Attorney, Managed Care (Pharmacy)

Why ThedaCare?   

Living A Life Inspired!

Our new vision at ThedaCare is bold, ambitious, and ignited by a shared passion to provide outstanding care. We are inspired to reinvent health care by becoming a proactive partner in health, enriching the lives of all and creating value in everything we do. Each of us are called to take action in delivering higher standards of care, lower costs and a healthier future for our patients, our families, our communities and our world. 

At ThedaCare, our team members are empowered to be the catalyst of change through our values of compassion, excellence, leadership, innovation, and agility.  A career means much more than excellent compensation and benefits. Our team members are supported by continued opportunities for learning and development, accessible and transparent leadership, and a commitment to work/life balance. If you’re interested in joining a health care system that is changing the face of care and well-being in our community, we encourage you to explore a future with ThedaCare.

Benefits, with a whole-person approach to wellness –

• Lifestyle Engagement
  • e.g. health coaches, relaxation rooms, health focused apps (Wonder, Ripple), mental health support  

• Access & Affordability
  • e.g. minimal or zero copays, team member cost sharing premiums, daycare

About ThedaCare!

Summary :Responsible for the legal 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) internal contract stakeholders and other organization leaders, consistent with the FTCH mission, vision, and enterprise values, including dispute resolution, and compliance therewith to managed care regulations.

Responsible for the 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 the FTCH mission, vision, and enterprise values, including dispute resolution related thereto.Job Description:

Contracting/Area of Expertise

• Functions as lead attorney in the drafting, review and negotiations of critical/complex managed care, pharmacy and key transaction contracts and delivers legal advice and recommendations to FTCH internal contract stakeholders and other organization leaders with respect to such contracts, including engaging, working with and managing outside legal counsel as necessary.
• Provide legal guidance on contractual obligations and risk management in areas of focus. Ensure proper documentation and compliance with contractual terms.

• Be proficient in and management of the system’s contracting function. 
• Works closing with VP, General Counsel (Corporate Law), Attorney Contracting Function and other department support staff to improve processes and systems to enhance the efficiency and effectiveness of the contracting function.
• Ensures proper deployment of OGC contracting team resources to assist with FTCH legal contracting matters and other contract-related duties for managed care, and other areas as directed.
• Functions as lead attorney in the support and resolution of legal contractual disputes related to managed care and other designated areas, such as payor demand letters, including coordinating with internal resources and outside legal counsel as necessary to resolve such disputes.
• Support FTCH on litigation and arbitrations arising from disputes with MCOs regarding denials of coverage, underpayment, or improper utilization management practices, and as otherwise required.
• Ensure organizational compliance with all relevant laws, regulations, and industry standards.
• Oversee and advise on internal policies and procedures related to managed care and provider contracts to mitigate legal risks.
• Monitor changes in pertinent legislation and regulations that may affect the company's operations.
• Collaborate with and support internal team to regarding company certification and audit programs, including HIPAA, HITRUST and SOC2, and manage to ensure proper monitoring and audit processes are followed.
• Preferred experience advising hospital or health group participation in pharmaceutical programs, including the Public Health Service Act 340B Drug Pricing Programs, membership in group purchasing organizations (GPOs), establishing and operating a Pharmacy Benefit Manager program, and drafting, reviewing and negotiating pricing, rebate and chargebacks and other agreements related thereto.

• Be an integral part of an 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 evaluation, ensuring delivery of high-quality contracting team-related legal services. 
• Primarily regarding managed care services and contracts, work closely with Attorney - Contracting Function to:
  • provide appropriate mentoring, training, support and development of the OGC contracting team, including attorney and non-attorney staff,
  • coordinate communication and development programs for the OGC contracting team,
  • develop and build relationships with system-wide business teams, and works closely and collaboratively, with internal and external business partners,
  • ensure cross-functional alignment on contracting matters,
  • create and drive relationships with other key company functions, identify dependencies and facilitate collaboration and problem-solving with cross functional teams, and
  • identify, collect, and report to appropriate executive teams on key performance indicators and service-level metrics concerning the OGC’s contracting team performance.

• Support and provide leadership, supervision, and development of the contracting professional support team, including recruitment, mentoring, performance management, and evaluation.

Technology and Processes

• Maximize use of and drive efficiencies in system’s contract management software system(s) and tools.
• Support and guide the OGC contracting staff responsible for the operations of the system’s contract management software system(s).

Qualifications: Minimum Experience and Education required and/or preferred

• Juris Doctorate (JD) from an accredited law school.
• 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.
• Must have a minimum of 4 years, with 5-8 years preferred of relevant contracting experience in a hospital or health system setting, healthcare environment, or law firm that specializes in managed care, 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.
• Deep understanding of federal and state laws governing managed care, including ERISA, HIPAA, and Wisconsin-specific regulations.
• 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

Flexible work arrangements available, with preference for hybrid (work and home office) schedule and residency in the State of Wisconsin within driving proximity of office locations in Milwaukee County and Outagamie County, Wisconsin.

Scheduled Weekly Hours:40Scheduled FTE:1Location:ThedaCare Corporate Office - Neenah,WisconsinOvertime Exempt:Yes