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Provider MCE Service Lead

Date:  Aug 6, 2022
Location: 

Dublin, OH, US, 43017-7565

Req ID:  7827

Summary

The position will be responsible for building and maintaining relationships with current Managed Care Organizations contracted with the Ohio Department of Medicaid.

 

They will support communication among the group with the Gainwell’s Single pharmacy benefit manager (PBM).

 

The MCE Liaison will coordinate non-urgent data needs that are not available in the portal but are available in Gainwell systems, clinical consultation requests,

coordinating pharmacy intervention activities with the MCEs, following up on patient care needs with the Gainwell Call Center, and triaging other communication requests.

Your role in our mission

 

  • Cultivate relationships to achieve performance and retention goals
     
  • Work directly with Managed Care organizations (MCO) pharmacy directors and care managers
     
  • Provide single point of contact and build relationship to assist Quality of Care
     
  • Identifies, provides data, counsels, and escalates concerns internally and with MCO’s
     
  • Provides communication and education around contractual obligations, and operational deliverables
     
  • Identifies risks, key issues, and patterns
     
  • Anticipates and escalates pharmacy or network issues
     
  • Researches and resolves inquiries and issues
     
  • Other duties as assigned/required

•    Primary point of contact for all MCEs

•    Develop Policies and Procedures for all aspects of Model Agreement

•    Develop workflows for all aspects of Model Agreement

 

What we're looking for

  • 1-2 years of managed care, insurance, or pharmacy benefit management experience preferred
     
  • Pharmacy experience preferred
     
  • Medicaid experience preferred
     

•    1-3 years’ MCO/PBM pharmacy experience

•    BS degree preferred but not required

•    Nursing background is helpful

•    Familiar with care coordination in an MCO setting

 

Apply now »