PBM Counsel for Health Plans & Government Programs

Blue Cross and Blue Shield of North Carolina; Utah; Hybrid; USD 131,000 - 209,000; Full time

Benefits offered by this job

Health coverage

Parental leave

Tuition reimbursement

401k match

Job summary

Blue Cross NC seeks an Associate Counsel to support PBM services, including work for the State Health Plan; you will help ensure contractual compliance and manage legal risk across PBM operations.

You will collaborate with pharmacy, compliance, operations, data, and finance teams, providing timely, legally sound guidance to internal partners and handling regulatory inquiries and audits related to health plan administration and PBM activities.

Qualifications

• Graduate of an accredited law school required.
• 3+ years of experience in related field.
• Licensed to practice law.

Responsibilities

• Develop and maintain working knowledge of PBM contracts and related legal requirements, including vendor obligations, performance guarantees, reporting, milestones, terms, audit rights, data obligations, and commitments.
• Review PBM-related materials and provide practical, legally sound guidance to business partners.
• Advise internal partners on interpretation and application of PBM contractual requirements including pharmacy benefit administration, claims processing, rebates, pricing, reporting, audits, and vendor performance.
• Serve as legal counsel supporting Blue Cross NC's PBM business and administration of the State Health Plan PBM contract.
• Advise on federal and state legal and regulatory requirements impacting PBM services and health plan administration, including privacy, data use, transparency, and compliance obligations.
• Support implementation and ongoing administration of PBM initiatives, vendor integrations, member communications, reporting processes, and workflows, including the NC State Health Plan.
• Advise on privacy, security, data governance, confidentiality, and information-sharing requirements for PBM services.
• Support responses to audits, investigations, inquiries, regulatory requests, reviews, and information requests.
• Assist with public records requests, confidentiality analyses, and protection of sensitive information.
• Monitor developments affecting PBM, government programs, and State Health Plan operations and communicate implications to stakeholders.
• Provide legal support on member complaints, appeals, grievances, claims, and vendor disputes.
• Develop and deliver training to business partners on legal, regulatory, and contractual topics relevant to the PBM contract.
• Provide support on developing legal issues and perform other duties as assigned.

Skills

PBM contracts

Regulatory compliance

Contract interpretation

Education

JD from accredited law school

Job description

Blue Cross NC seeks an Associate Counsel to support PBM services, including work for the State Health Plan; you will help ensure contractual compliance and manage legal risk across PBM operations.

You will collaborate with pharmacy, compliance, operations, data, and finance teams, providing timely, legally sound guidance to internal partners and handling regulatory inquiries and audits related to health plan administration and PBM activities.