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Pharmacy Manager Service Delivery

Role overview

Qualifications

  • 10+ years of software testing experience
  • 5+ years of Test Management experience
  • Strong PBM or Medicaid pharmacy experience
  • Experience with large-scale DDI or MMIS modernization programs

Responsibilities

  • Lead end-to-end pharmacy testing across SIT, UAT, Regression, Parallel Testing, and Production Validation
  • Develop and manage test strategy, plans, schedules, and execution governance
  • Oversee pharmacy functional validation including claims adjudication, drug pricing, formulary management
  • Manage defects and cross-functional coordination among business SMEs, vendors, developers

Key facts

Hard skills

Other skills

  • 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

 

Be part of a team that unleashes the power of leading-edge technologies to help improve the health and well-being of those most vulnerable in our country and communities. Working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work flexibility, learning, and career development. You’ll add to your technical credentials and certifications while enjoying a generous, flexible vacation policy and educational assistance. We also have comprehensive leadership and technical development academies to help build your skills and capabilities.

Summary

As a ​Pharmacy Manager Service Delivery at Gainwell, you can contribute your skills as we harness the power of technology to help our clients improve the health and well-being of the members they serve — a community’s most vulnerable. Connect your passion with purpose, teaming with people who thrive on finding innovative solutions to some of healthcare’s biggest challenges. Here are the details on this position.

Your role in our mission

  • Lead end-to-end pharmacy testing across SIT, UAT, Regression, Parallel Testing, and Production Validation to ensure quality delivery of PBM and Medicaid pharmacy solutions.
  • Develop and manage test strategy, plans, schedules, and execution governance, ensuring alignment with business requirements, CMS guidelines, and state Medicaid regulations.
  • Oversee pharmacy functional validation, including claims adjudication, drug pricing, formulary management, prior authorization, rebates, NCPDP transactions, and financial reconciliation processes.
  • Manage defects and cross-functional coordination among business SMEs, vendors, developers, conversion teams, and testing resources to ensure timely issue resolution and testing readiness.
  • Provide leadership reporting and stakeholder communication by tracking quality metrics, risks, issues, and test progress.

What we're looking for

  • 10+ years of software testing experience.
  • 5+ years of Test Management experience.
  • Strong PBM or Medicaid pharmacy experience.
  • Experience with large-scale DDI or MMIS modernization programs.
  • Expertise in: Claims adjudication , NCPDP transactions , Prior Authorization , Formulary management , Drug Rebate processing , Pharmacy financial validation
  • Experience using ALM/JIRA and SQL for data validation.

What you should expect in this role

  • Fully Remote Opportunity – Work from anywhere in the U.S.  
  • Minimal Travel Required – Occasional travel opportunities (0-10%).  
  • Video cameras must be used during all interviews, as well as during the initial week of orientation

#LI-REMOTE

#LI-GD1

The pay range for this position is $86,700.00 - $123,900.00 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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MR

Marcus Rivera

Chief Revenue Officer

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