Manager, Customer Support

Gainwell Technologies LLC•Any city, OH

7d•$75,700 - $108,100

About The Position

Leads customer support operations for Prior Authorization (PA) services within the state PBM (sPBM) program. Ensures high-quality service delivery, regulatory compliance, and efficient processing of pharmacy benefit requests. This role involves leading and developing customer support teams managing prior authorization workflows and member/provider inquiries, driving performance across key operational metrics (service levels, quality, turnaround times, productivity), and overseeing escalations to ensure timely resolution of complex PA and pharmacy-related issues. The position also requires ensuring compliance with state Medicaid requirements, clinical guidelines, and PBM regulations, and partnering with clinical, operations, and state stakeholders to improve processes and service delivery.

Requirements

High school diploma or equivalent required
5+ years of PBM, healthcare call center, or prior authorization experience
2+ years of leadership or team management experience
Strong knowledge of prior authorization processes, pharmacy benefits, and Medicaid programs
Experience managing KPIs, reporting, and operational performance

Responsibilities

Lead and develop customer support teams managing prior authorization workflows and member/provider inquiries
Drive performance across key operational metrics (service levels, quality, turnaround times, productivity)
Oversee escalations and ensure timely resolution of complex PA and pharmacy-related issues
Ensure compliance with state Medicaid requirements, clinical guidelines, and PBM regulations
Partner with clinical, operations, and state stakeholders to improve processes and service delivery