Support CarelonRx and its pharmacy networksResponsible for all state and federal licensing and accreditations: PBM, TPA, Dept of Insurance, UR, Boards of Pharmacy, DEA, URAC and NCQADraft, review and negotiate all pharmacy related contracts: network, partners and vendor Support and analyze risks as it relates to product and program offeringsProvide guidance to compliance regarding mail order and specialty pharmacy regulatory requirements Provide legislative and regulatory comments impacting the enterprise Overall provide service to people across their entire healthcare journey and connecting them to the care, support and resources needed to lead healthy lives.

Draft and negotiate specialty payor direct and integrated agreements for Accredo Health Group, Inc., a specialty pharmacy subsidiary of ESI, Freedom Fertility, and CareContinuum, ESI's medical benefit utilization management subsidiary.Legal analysis of general healthcare laws and regulations relating to ESI's Retail Pharmacy Network and its prescription savings program and pet medication program, Inside Rx. Provide claim adjudication guidance affecting the pharmacy benefits management, Inside Rx, Medicare, and specialty pharmacy businesses. Represent Accredo during pre and post payment appeals, including representation at Administrative Law Judge hearings for Medicare/Medicaid Payment Appeals. Prepare pre-hearing documentation (correspondence, briefs, and exhibits) and conduct witness preparation.Provide strategic advice and responses to audit findings and additional documentation requests to mitigate proposed findings communicated between State and Federal agencies and Accredo, as well as commercial payors. Provide protocol guidance to internal audit to test against state and federal requirements. Review Corrective Action Plans and ensure dissemination to appropriate stakeholders to avoid reoccurrence.Provide legal support to internal Compliance Department and Pharmacy Practice on various Medicare/ Medicaid issues as well as provide legal advice to various business stakeholders concerning Medicare Part B.Advise corporate licensing team with legal, regulatory guidance related to its licensing and compliance requirements for pharmacy and non-pharmacy applications and audits, which include licensure for resident and non-resident state pharmacies, third party administrators, pharmacy benefit managements, utilization reviews, and prescription discount cards.Research and provide guidance on special regulatory projects concerning central fill, federal DEA requirements, and various other pharmacy matters.

Coordinate and manage all corporate licensing requirements for all pharmacy and non-pharmacy licenses and applications, including third party administrators, pharmacy benefit managements, utilization reviews, and discount cards, as well as pharmacy applications and licenses for country-wide Board of Pharmacies.Create licensing process flows for efficiency and consistency on all applications.Review and comment on State and Federal pending legislation that may impact licensing. Develop pipelines to ensure compliance with State and Federal licensing laws.

Provide legal analytical support and assistance to General Counsel through research and analysis of Code and case law to resolve legal issues and draft memoranda regarding results of same. Prepare responses to administrative complaints of statutory violations, including interviewing clients/witnesses to ascertain facts, gathering evidence to formulate appropriate responses, examining legal data to determine advisability of response and evaluating findings to develop strategy and arguments in defense of such actions. Oversee and coordinate objections and responses to subpoena and document requests for employment records received by Medco and subsidiaries. Oversee and coordinate objections and responses to discovery requests in employment litigation matters. Coordinate activities of outside counsel and Medco personnel concerning immigration and workers’ compensation matters.

Researched, promulgated, edited and amended administrative regulations for the State of New Jersey’s Professional and Occupational Boards.Reviewed, analyzed and provided opinions on legislative, regulatory and judicial developments that impact the Division and its professional and occupational boards. Reviewed pending legislation/bills, prepared analyses and comments regarding same, and provided the Division’s position/opinion regarding the expected fiscal, programmatic, legal and regulatory impact for the pending legislation/bills. Participated in multi-state litigation groups coordinated through the National Association of Attorneys General. Enforced all aspects of consumer protection by assisting in overseeing the Office of Consumer Protection; the Office of Weights and Measures; the Bureau of Securities; Legalized Games of Chance; Regulated Business; New and Used Car Lemon Law.