Pharmacy Provider Relations Manager

Gainwell Technologies; Kentucky; On-site; USD 114,000 - 163,000; Full time

Benefits offered by this job

Flexible vacation policy

401(k) match

Health benefits

Educational assistance

Leadership development academies

Technical development academies

Job summary

Gainwell Technologies seeks a Provider Contract Lead to support Ohio Medicaid pharmacy network management. You will lead outreach, contract execution, and ongoing network maintenance, coordinating with internal teams to ensure access, accuracy, and compliance.

The role requires 5+ years in PBM or related fields, 2+ years of leadership, strong data reporting skills, and ability to work Eastern Time hours. This is a full-time, on-site position in Ohio with competitive pay and benefits.

Qualifications

• 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, and support process improvement, new service needs, and RFP-related activities

Job description

Great companies need great teams to propel their operations. Join the group that solves business challenges and enhances the way we work and grow. Working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values your contributions and puts a premium on work flexibility, learning, and career development.

Summary

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.

Your role in our mission

• 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, and support process improvement, new service needs, and RFP-related activities

What We're Looking For

• 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

What You Should Expect In This Role

• 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

The deadline to submit applications for this posting is August 31, 2026.

The pay range for this position is $113,900.00 - $162,700.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors.

Benefits

• All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance.
• We also have a variety of leadership and technical development academies to help build your skills and capabilities.

We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.

Gainwell Technologies is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Gainwell Technologies defines “wages” and “wage rates” to include “all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.