Provider Relations Managed Care Access, Sr. Manager
GEMCORE’s continued success has earned us national recognition with Inc. Magazine’s list of America’s Fastest-Growing Companies and with the Cleveland Plain Dealer as Top Workplace 6 years running! We are looking for qualified candidates who share our enthusiasm and drive for winning and want to be part of our caring culture!
Are you looking for a role that is part of a key initiative that is vital for the growth of the organization? All the while allowing for work/life balance? GEMCORE is a well-established and growing healthcare distribution company specializing in highly efficient distribution through its nationwide wholesale, retail, and pharmacy divisions. We are seeking a highly motivated Sr. Manager, Provider Relations Managed Care Access to play a critical role in the key growth initiative supporting our Market Access and Payer Strategy Objectives. The
Sr. Manager, Provider Relations Managed Care Access’s main responsibility is to manage the GEMCORE Family of Companies Key Payer Network Program consistent with company growth objectives.
We offer growth opportunities with potential for advancement
This position is an in-office position located in Hudson, OH
Schedule is 8:15 am - 5:00 pm, Monday through Friday
Employer paid vacation
Benefits available included medical/dental/vision, life, short and long-term disability insurances, and 401K Retirement Savings Plan
Ongoing training and development
Key duties and responsibilities:
Lead payer partnerships and market access initiatives, remaining current on evolving payer, PBM, and managed care trends across commercial, Medicare, Medicaid, provider network, and self-funded markets
Drive payer strategy and payer network development, identifying opportunities to expand and strengthen health plan engagement
Secure and manage managed care and PBM contracts, including payer contract negotiation, renewals, and amendments
Evaluate payer and PBM contract profitability, ensuring alignment with divisional financial objectives and access strategy
Conduct detailed contract review, rate analysis, and fee schedule evaluation to support favorable reimbursement outcomes
Identify and assess payer marketing and strategic channels, recommending tactics to maximize payer contract utilization and performance
Develop and maintain strong relationships with payer and PBM decision-makers, effectively positioning GEMCORE’s differentiated services and capabilities.
Communicate payer contract updates, policy changes, and reimbursement impacts to internal stakeholders in a timely manner.
Key Requirements:
Knowledge of HCPC coding.
Familiarity with durable medical equipment fee schedules.
Experience or exposure to managed care contracting, payer relations, or network management.
Working knowledge of health insurance and PBM organizations preferred.
Advanced research and problem- solving capacity.
Ability to multi-task, adapt to change and prioritize work assignments.
Proficient with all Microsoft Office applications Word, Excel, PowerPoint etc. with high internet acumen.
Good organizational and cognitive reasoning ability.
Strong written and verbal communication skills.
5-7 years of experience in provider relations or network management.
College degree, preferred.
Light lifting of up to 25 pounds.
Some travel as required.