Ohio Medicaid PBM Operations Manager


Job Description:

  • In partnership with the client, development of strategic direction of pharmacy team and operations
  • Development and/or sponsorship of new initiatives
  • Collaboration and communication with partners
  • Monitoring/reporting of service level agreements, contract issues, performance measures
  • Implementation of strategies/solutions to streamline program policies and operations to achieve program cost savings
  • Oversees, supports, and monitors day-to-day activitiesto ensure timely and effective execution
  • Coordinates maintenance activities with Ohio Department of Medicaid (ODM) PMO and other impacted Ohio Medicaid Enterprise Solution (OMES) Project Managers
  • Authorizes when to escalate and resolve implementation and operational issues to meet contract expectations
  • Coordinates information for andparticipate in appeals and grievances meetings and hearings


  • Bachelor’s degree in Insurance, Healthcare, or related field or equivalent work experience. Advanced degree in related field is a plus.
  • 5+ years of in Pharmacy Benefits Management solution operations
  • Two or more of the following preferred:
  • experience
  • Experience working in a PBM/Managed Care environment
  • Prior experience working with or overseeing subcontractors
  • Prior experience with Medicaid
  • Prior experience with pharmacy claims from an insurer, managed care, or PBM perspective
  • Prior experience with quality oversight of PA (prior authorization) processing
  • Prior experience with insurer, managed care, or PBM regulatory compliance
  • Prior experience addressing provider issues for an insurer, managed care organization, or PBM
  • Prior experience with DUR, 340B, Drug Rebate, Drug Reimbursement, Drug Pricing
  • Experience working with medical policy and/or health care information systems a plus
  • Excellent communication skills

Gainwell Technologies is an equal opportunity employer. We welcome the many dimensions of diversity. Accommodation of special needs for qualified candidates may be considered within the framework of the Gainwell Technologies Accommodation Policy.

In addition, Gainwell Technologies is committed to working with and providing reasonable accommodation to qualified individuals with physical and mental disabilities.



Clipped from: https://tarta.ai/j/gkUbxHgBrJRKg1c1oLx1-ohio-medicaid-pbm-operations-manager-in-dublin-ohio-at-gainwell-technologies?utm_campaign=google_jobs_apply&utm_source=google_jobs_apply&utm_medium=organic