Corporate Counsel - PBM and Payer Contracts

Overview

A healthcare organization specializing in rare disease pharmacy is seeking a Corporate Counsel with expertise in pharmacy benefit management (PBM), payer contracting, and government healthcare programs such as Medicare and Medicaid. This full-time, exempt position reports to the Chief Legal Officer and is based in Pittsburgh, PA, with a hybrid work schedule.

Responsibilities

• Provide legal counsel on federal and state healthcare regulations affecting PBM operations, payer relationships, and government program participation (e.g., Medicare Part D, Medicaid Managed Care).
• Advise on CMS guidelines, Medicaid regulations, and other relevant laws and advisory opinions.
• Draft, review, and negotiate contracts with PBMs, health plans, payers, and government entities, ensuring compliance and alignment with business objectives.
• Support vendor and service agreement negotiations as needed.
• Collaborate with compliance and quality teams to ensure adherence to healthcare laws and accreditation standards.
• Provide legal support for licensing and regulatory filings across multiple jurisdictions.
• Advise on employment-related legal matters, including labor law compliance, employee relations, and internal investigations.
• Serve as a legal advisor to business leaders, offering strategic guidance and risk mitigation.
• Support general operational legal matters.
• Manage outside counsel for litigation, regulatory investigations, and third-party subpoenas; coordinate document production and discovery responses.
• Partner with internal stakeholders across departments to support strategic initiatives and ensure legal alignment.
• Perform additional responsibilities as assigned by the Chief Legal Officer.

Required Qualifications

• Juris Doctor (JD) degree from an accredited law school.
• Minimum of four (4) years of legal experience, preferably in PBM, payer contracting, or government healthcare programs.
• Licensed attorney in good standing in at least one U.S. jurisdiction.
• Strong knowledge of healthcare regulations, including CMS, Medicare/Medicaid, and payer contracting frameworks.
• Proven experience negotiating contracts with PBMs, health plans, and government entities.
• Excellent analytical, communication, and organizational skills.
• Ability to manage multiple priorities independently and collaboratively.

Preferred Qualifications

• Experience with employment law, compliance, and litigation management.

Work Environment

This role operates in a home or professional office environment and routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets, and fax machines.

Physical Demands

• Regularly required to see, talk, or hear.
• Frequently required to sit, stand, walk, use hands and fingers, handle or feel, and reach with hands and arms.
• Visual acuity necessary for reading, observing surroundings, and working with various forms of data.
• Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.

Compensation & Benefits

• Hybrid, remote, and flexible on-site work schedules available depending on position.
• Comprehensive benefits package including medical, dental, vision, health savings and flexible spending accounts.
• 401(k) plan with employer matching.
• Employer-paid life insurance and short/long-term disability coverage.
• Employee Assistance Program.
• Generous paid time off for full-time employees; limited paid time off for part-time employees.
• Paid holidays.

Location

Pittsburgh, Pennsylvania (Hybrid work arrangement)