Pharmacy Provider Relations Manager

🔥 0 minutes ago

🏈 Ohio – Remote

🏈 Ohio – Remote

💵 $113.9k - $162.7k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

💰 Account Manager

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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Gainwell Technologies

WebsiteLinkedInAll Job Openings

10,000+ employees

💼 Consulting

📦 Logistics

⚕️ Healthcare Insurance

💰 Grant on 2023-06

Consulting • Logistics • Healthcare Insurance

Gainwell Technologies is the nation’s leading provider of digital and cloud-enabled solutions across the human services and public health ecosystem. With a mission-driven approach, Gainwell serves clients in all 50 U. S. states, focusing on improving health outcomes and delivering intuitive, human-centered experiences. Their comprehensive suite of solutions includes Medicaid Enterprise modernization, data analytics, provider services, and pharmacy solutions, all designed to advance the future of healthcare and enhance community well-being.

📋 Description

• Manage relationships with pharmacies in Ohio’s network and support pharmacy outreach, contract execution, and ongoing network maintenance • Serve as a liaison between pharmacies and internal Gainwell teams, including finance, claims, operations, compliance, and client-facing partners • Monitor pharmacy network adequacy, access-to-care requirements, and network-to-pharmacy issues, including member access and travel considerations • Maintain accurate provider directory information, pharmacy network data, policies, procedures, and out-of-network processes • Support Ohio claims-related communications by ensuring pharmacy network information is accurate, timely, and distributed to pharmacy staff • Run operational, KPI, client, monthly, quarterly, and pharmacy network management reports • Support third-party audits, including CMS, ISCA, and Ohio Department of Medicaid audits • Identify risks, resolve inquiries, escalate network issues, and support process improvement, new service needs, and RFP-related activities • Communicate regularly with pharmacies, internal Gainwell partners, and Ohio Medicaid-related stakeholders • Partner with finance, claims, operations, compliance, and client-facing teams to support network performance

🎯 Requirements

• 5+ years of experience in PBM, pharmacy operations, drug claims processing, pharmacy network management, or contracting • 2+ years of leadership or supervisory experience • Pharmacy network management experience within Ohio Medicaid or PBM environments strongly preferred • Strong knowledge of pharmacy claims adjudication, Medicaid programs, PBM operations, and pharmacy network maintenance • Experience with client communications, client-facing discussions, relationship management, and cross-functional partnership • Experience with operational reporting, KPIs, audits, process improvement, data analysis, and Excel • Ability to work with urgency, manage multiple priorities, communicate clearly in a fast-paced, time-sensitive environment, and support Eastern Time business hours • Must be able to work Eastern Time hours

🏖️ Benefits

• Work flexibility • Learning and career development • Generous, flexible vacation policy • 401(k) employer match • Comprehensive health benefits • Educational assistance • Leadership and technical development academies