Counsel-Client Contracting (eviCore )

Counsel will be a key member of the eviCore healthcare’s client contracting team, serving as a legal advisor to a key subsidiary of Cigna’s Evernorth business, and will focus on providing legal guidance and solutions for regulatory and contract challenges impacting eviCore healthcare, which provides utilization review, quality management, and related medical benefits management services. This role requires seasoned judgment, significant contracting experience, the ability to negotiate directly with external clients, the ability to work independently, comfort with working through ambiguity, strong attention to detail, and regulatory expertise. To be successful, this individual must gain an understanding of eviCore’s business and pricing models and develop the ability to draft language to support novel and complex contract arrangements. The successful candidate will operate as a thought partner and collaborate with business leadership and other internal professionals, including those in: Sales and Product; Compliance; Government Affairs; Enterprise Risk Management; and Services & Solutions. This position requires a customer-focused mind-set and a keen understanding of the perspectives of key internal and external stakeholders, including growth, business leaders, customers and clients, and regulators and enforcement agencies. The Counsel must gain an understanding of applicable state and federal laws and regulations, including: laws pertaining to utilization management, third party administrators, risk-bearing or capitated arrangements, and federal and state privacy laws and regulations (including the HIPAA Privacy Rule). Key Responsibilities: Through the provision of innovative and risk based legal advice, support the product and business teams by ensuring compliant administration and contracting of the eviCore product suite; Responsible for negotiating anddrafting the legal and business terms of eviCore’s client contracts for all solutions and compensation models. This includes arrangements for the provision of eviCore solutions to Commercial, Medicare Advantage, and Medicaid (fee-for-service and managed Medicaid) populations enrolled in plans throughout the United States, with related legal and regulatory considerations; Coordinate with fellow Legal and Enterprise Compliance partners to ensure the business partners are receiving consistent legal and regulatory support and are apprised of key risks and issues in a timely manner; Identify key trends or gaps arising out of processes occurring in Evernorth's medical management and Service Operations areas; Promote a culture of compliance, accountability, transparency and ethical decision-making. Qualifications: Juris Doctor required. 3-5 years of commercial contracting experience in positions of increasing responsibility, with at least a portion of practice focused on the negotiating and drafting of healthcare transactions. Strong, independent decision-making ability and problem solving skills Familiarity with concepts, practices, and procedures related to the managed care industry is preferred. Ability to understand complex operations, technological, and financial issues related to eviCore's products. Understands the importance of supporting business leaders to enable sustainable growth. Able to render actionable legal advice within a matrixed business setting, balancing the need to avoid unnecessary or inappropriate risk with the need to achieve business goals. Identifies and researches legal issues pertinent to Evernorth/eviCore and its interests, and assists in the development of clear recommendations regarding eviCore’s legal obligations and options. Personable, highly collaborative individual with the ability to influence others and build strong professional relationships. Consistent sound judgment and incisive, three-dimensional analytical abilities. Outstanding verbal and written communications skills. Highly organized with a strong attention to detail. Intellectual flexibility; adept at reassessing priorities to ensure that internal and external expectations are fulfilled. Strong ability to navigate through barriers to drive successful initiatives throughout the business. Ability to multi-task and appropriately prioritize and manage multiple projects under tight deadlines. Ability to work more than 40 hours per week. If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. For this position, we anticipate offering an annual salary of 132,700 - 221,100 USD / yearly, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus plan. At The Cigna Group, you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, click here. About Evernorth Health Services Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. If you need a reasonable accommodation to complete the online application process, please email [email protected] for assistance. Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes. The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances. Apply To This Job