Gainwell is seeking a motivated and experienced Network Manager to join our team. As a Network Manager, you will play a pivotal role in building and managing a pharmacy network that aligns with the access, adequacy, and performance needs of our Ohio Medicaid health plan. The successful candidate will lead in contracting, reporting, compliance, and overall network strategy and performance.

Responsibilities:

• Plan, organize, and lead the activities of the pharmacy network staff.
• Cultivate strong relationships with pharmacy networks to achieve performance and retention goals.
• Develop and maintain legally-valid pharmacy network contract templates.
• Negotiate contracts with pharmacies, coordinating in-house legal reviews.
• Identify provider network additions, deletions, or changes based on historical trends or current trajectories.
• Develop and maintain a provider directory.
• Develop and maintain policies and procedures for the administration of the pharmacy network.
• Create and implement Gainwell pharmacy network strategies to support cost and quality improvement.
• Ensure pharmacy network databases are current and accurate.
• Develop and maintain an out-of-network process.
• Create useful management and client reports and profiling.
• Maintain network compliance with federal, state, contractual, and other regulatory requirements.
• Facilitate real-time performance monitoring to achieve service level agreement requirements.
• Ensure network pharmacies receive communication and education regarding contractual obligations and operational deliverables.
• Develop and implement strategies and sanctions for non-compliance to performance expectations, contractual obligations, and Fraud, Waste, and Abuse.
• Identify risks, key issues, and patterns from partial/conflicting data.
• Anticipate and escalate pharmacy network issues.
• Ensure inquiries and issues are researched and resolved.
• Provide input to the management team on new product or service features.
• Assist in the development of RFP responses describing Gainwell's pharmacy network.
• Other duties as assigned/required.

Education and Experience:

• Bachelor's degree in Business Management, Insurance, Healthcare, or related field preferred or equivalent work experience.
• Previous experience managing a network required.
• 1-2 years of managed care, insurance, or pharmacy benefit management experience preferred.
• Pharmacy experience preferred.
• Medicaid experience preferred.
• 4 years of managerial experience preferred.
• Understanding of the legal and operational aspects of contracting is important.

Key Competencies:

• Strong verbal and written communication skills.
• Approachable and professional in all interactions.
• Strong project management experience to organize multiple projects concurrently.
• Ability to gather and analyze data.
• Assures accuracy, quality, and efficiency in tasks.
• General computer knowledge including Microsoft Office, Microsoft Excel, use of the internet, and email is required.
• Ability to solve problems and make sound decisions with no supervision.
• Ability to adapt and work collaboratively in a fast-paced environment.
• Willingness to work a flexible schedule.
• Consistent presentation skills.
• Meet objectives and quality standards for clients. Completes work with a limited degree of supervision. Takes a broad perspective on problems and spots new, less obvious solutions.

If you possess these qualifications and are ready to take on a challenging and rewarding role, we encourage you to apply. Gainwell is an equal opportunity employer committed to diversity and inclusion in the workplace.

Looking for remote jobs near your area? At Yulys, thousands of employers are looking for exceptional talent like yours. Find perfect job now.