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Lead end-to-end pharmacy testing across SIT, UAT, and regression cycles while ensuring compliance with Medicaid regulations. Manage cross-functional coordination and provide leadership reporting on quality metrics, risks, and test progress.
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.
As a Experienced Test Manager - PBM (Pharmacy Benefit Manager) 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.
• Lead end-to-end pharmacy testing across SIT, UAT, Regression, and Parallel Testing for F6 transaction formats, ensuring quality delivery of PBM and Medicaid pharmacy solutions.
• Develop and manage test strategy, plans, schedules, and execution governance, ensuring alignment with compliance timelines and state Medicaid regulations.
• Validate and enforce NCPDP F6 transaction routing, data crosswalks, expanded product identifiers, and telephony compliance, including the D.0 to F6 transition across 271 Eligibility Response and Formulary and Benefit outbound extracts.
• Oversee pharmacy functional validation, including claims adjudication, drug pricing, formulary management, prior authorization, DUR, COB, rebates, and pharmacy financial reconciliation.
• Manage defects and cross-functional coordination among business SMEs, PBMs, switch networks, vendors, developers, conversion teams, and onshore/offshore testing resources to ensure timely issue resolution.
• Provide leadership reporting and sponsor-facing stakeholder communication by tracking quality metrics, risks, issues, and test progress.
• 10+ years of software testing experience.
• 5+ years of Test Management experience.
• Strong PBM or Medicaid pharmacy experience, with direct exposure to NCPDP standards transitions (D.0, F2, or F6).
• Experience with large-scale DDI or MMIS modernization programs.
• Expertise in: Claims adjudication, NCPDP transactions, Prior Authorization, Formulary management, Drug Rebate processing, Eligibility (270/271) processing, Pharmacy financial validation.
• Experience using ALM/JIRA and SQL for data validation.
• Strong leadership, communication, and stakeholder management skills.
The pay range for this position is $90,900 - $129,900 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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