SummaryThis 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.
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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.
