Remote Pharmacy Network Lead Ohio Medicaid

Gainwell Technologies; Northern (KY); Hybrid; USD 114,000 - 163,000; Full time

Benefits offered by this job

401(k) employer match

Health benefits

Educational assistance

Flexible vacation policy

Job summary

Gainwell Technologies is seeking a Pharmacy Provider Relations Manager to support Ohio Medicaid pharmacy networks. The role involves managing relationships with Ohio pharmacies, executing contracts, and maintaining network data to ensure access and compliance.

You will work Eastern Time hours in a remote-capable environment. Responsibilities include KPI reporting, audits support, and cross-functional collaboration with finance, claims, operations, and compliance teams.

Qualifications

• 5+ years in PBM, pharmacy operations, drug claims processing, or contracting.
• 2+ years in leadership or supervisory roles.
• Experience with Ohio Medicaid or PBM networks preferred.
• Strong knowledge of pharmacy claims adjudication and Medicaid programs.

Responsibilities

• Manage relationships with pharmacies in Ohio’s network and support outreach, contract execution, and maintenance.
• Serve as liaison between pharmacies and internal Gainwell teams (finance, claims, operations, compliance, client-facing).
• Monitor network adequacy, access-to-care requirements, and network-to-pharmacy issues including member access and travel.

Skills

PBM knowledge

Pharmacy operations

Contracting

Client communications

Data analysis & Excel

Job description

Gainwell Technologies is seeking a Pharmacy Provider Relations Manager to support Ohio Medicaid pharmacy networks. The role involves managing relationships with Ohio pharmacies, executing contracts, and maintaining network data to ensure access and compliance.

You will work Eastern Time hours in a remote-capable environment. Responsibilities include KPI reporting, audits support, and cross-functional collaboration with finance, claims, operations, and compliance teams.