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Senior Manager, Pharmacy Testing

Role overview

Qualifications

  • 13+ years of experience leading end-to-end testing strategy and execution for large-scale Medicaid PBM implementations
  • Deep expertise in pharmacy operations and PBM platforms, including claims adjudication
  • Proven experience leading SIT, UAT, regression, automation, and production readiness activities
  • Strong knowledge of Medicaid regulations, CMS requirements, and compliance standards

Responsibilities

  • Lead the strategy, planning, governance, and execution of end-to-end pharmacy testing
  • Establish testing standards, methodologies, tools, and quality frameworks
  • Oversee multi-vendor and onshore/offshore testing teams
  • Drive continuous improvement initiatives that increase testing efficiency and client satisfaction

Key facts

  • Remote from: Indiana (USA)
  • Full time
  • Senior (5-10 years)
  • English

Hard skills

Other skills

  • Quality Assurance
  • Collaboration
  • Leadership

About the company

Gainwell Technologies LLC logo

Gainwell Technologies LLC

Digital Health & Health Tech

For 50 years, our nation’s federal Medicaid program has worked to improve the health, safety and well-being of America’s most vulnerable populations: low-income families, women and children, seniors, and those with disabilities. With positive health and cost outcomes that pierce inequities and impact economies, the success of these programs is inextricably tied to the prosperity of communities, individual states and the nation as a whole. We think that demands respect and, more importantly, is deserving of a lifetime commitment from innovators who can help those who operate within and around health and human services evolve — in any market at any stage. At Gainwell Technologies, that’s our sole focus. Built across more than five decades, Gainwell has intentionally seized opportunities to advance its digitally enabled services to meet agencies, health plans and MCOs where they are on their modernization journeys and propel them into the future of public health. Our commitment to innovation, deep experience and ability to leverage insights from customers across 50 states has allowed us to expand on next-generation, cloud-enabled technologies. Today, Gainwell offers one of the most comprehensive suites of scalable services and solutions on the market — all proven to deliver cost savings, better patient outcomes and an improved provider experience. Equally important to our expanding technologies and results: We bring ideas that bring policies to life.

Company details

Company typeLarge
IndustryDigital Health & Health Tech
Company size10001

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Job description

 

Great companies need great teams to propel their operations. Join the group that solves business challenges and enhances the way we work and grow. Working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values your contributions and puts a premium on work flexibility, learning, and career development. 

Summary

This role provides executive-level leadership for Pharmacy Benefit Management (PBM) quality assurance and testing across large-scale Medicaid implementations and operations. The position is responsible for defining and executing enterprise testing strategies that ensure compliant, high-quality, and reliable pharmacy solutions. This leader partners closely with business, product, state, implementation, and delivery teams while overseeing testing organizations, vendor partners, budgets, and quality initiatives to drive successful client outcomes and continuous service improvement.

Your role in our mission

  • Lead the strategy, planning, governance, and execution of end-to-end pharmacy testing across Medicaid PBM implementations and production enhancements.
  • Establish testing standards, methodologies, tools, and quality frameworks to support system integration testing (SIT), user acceptance testing (UAT), regression testing, automation, parallel testing, and production readiness activities.
  • Partner with business, product, implementation, and state stakeholders to ensure requirements are validated and aligned with regulatory, contractual, and operational expectations.
  • Oversee multi-vendor and onshore/offshore testing teams, ensuring accountability for test execution, defect management, quality outcomes, and delivery timelines.
  • Develop demand forecasts and resource plans to support implementation schedules and operational priorities.
  • Prepare, manage, and monitor operating and personnel budgets, ensuring effective use of resources and adherence to financial targets.
  • Establish and report key quality metrics, testing KPIs, defect trends, and executive dashboards to provide transparency into program health and readiness.Identify, assess, and mitigate risks, dependencies, and quality issues that could impact implementation or operational performance.
  • Drive continuous improvement initiatives that increase testing efficiency, automation adoption, quality outcomes, and client satisfaction.
  • Support business development efforts by contributing pharmacy testing expertise, implementation strategies, and solution recommendations for new opportunities.

What we're looking for

  • 13+ years of experience leading end-to-end testing strategy and execution for large-scale Medicaid PBM implementations.
  • Deep expertise in pharmacy operations and PBM platforms, including claims adjudication (NCPDP D.0/F6), formularies/PDLs, DUR, rebates, encounters, prior authorization, and financial reconciliation processes.
  • Proven experience leading SIT, UAT, regression, automation, parallel testing, and production readiness activities across complex healthcare technology environments.
  • Demonstrated success managing large, geographically distributed testing teams, including vendor, onshore, and offshore resources.
  • Strong knowledge of Medicaid regulations, CMS requirements, state-specific pharmacy programs, and compliance standards.
  • Experience establishing testing governance models, quality frameworks, KPIs, executive reporting, and continuous improvement programs.
  • Ability to influence and collaborate effectively with executive leadership, clients, state stakeholders, product teams, and delivery organizations.
  • Bachelor's degree or equivalent combination of education and experience. Advanced degree preferred.

What you should expect in this role

  • Remote opportunity to work anywhere in the US
  • Up to 10% travel required.

The deadline to submit applications for this posting is 10/5/2026.

#LI-LM1

#LI-REMOTE

The pay range for this position is $140,000 - $160,000 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.

We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.

Gainwell Technologies is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Gainwell Technologies defines “wages” and “wage rates” to include “all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.

 

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Marcus Rivera

Chief Revenue Officer

m.rivera@company.com
linkedin.com/in/marcusrivera
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