Pharmacy Provider Relations Manager

Gainwell Technologies LLC•Any city, OH

3d•$113,900 - $162,700•Remote

About The Position

The Provider Contract Lead will support Gainwell’s work as the SPBM for Ohio by helping build, maintain, and manage the Ohio Medicaid pharmacy network. This role is responsible for pharmacy outreach, contract execution, ongoing network maintenance, claims-related communications, reporting, and network adequacy monitoring to ensure pharmacy access, accuracy, compliance, and operational performance. This role must be able to work Eastern Time hours. A client-facing role with regular communication across pharmacies, internal Gainwell partners, and Ohio Medicaid-related stakeholders. A fast-paced, time-sensitive environment where requests may need quick turnaround and timely follow-through. Hands-on involvement in pharmacy network updates, claims-related communications, provider directory accuracy, and operational reporting. Responsibility for monitoring network adequacy, access-to-care needs, and issues that may impact pharmacy availability for members. Ongoing partnership with finance, claims, operations, compliance, and client-facing teams to support network performance. Support for monthly and quarterly reporting, third-party audits, KPI updates, process improvement efforts, and Eastern Time working hours.

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

Responsibilities

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 to support performance monitoring and decision-making
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