SummaryDrives the vision, strategy, growth, and execution of Gainwell's Medicaid Pharmacy Administration and Technology portfolio, including pharmacy benefit administration, claims processing, clinical and utilization management solutions, rebate management, preferred drug list (PDL) management, point-of-sale (POS) adjudication, pharmacy network management, interoperability, and emerging pharmacy technologies. Leads the development and execution of product strategy that aligns with federal and state Medicaid policy, CMS regulations, and evolving market needs while ensuring attainment of the organization's financial, operational, and strategic business objectives.
Develops and expands Gainwell's market leadership in Medicaid pharmacy technology by building trusted relationships with state Medicaid agencies, industry partners, and executive stakeholders. Champions innovation, product modernization, digital transformation, and operational excellence across the pharmacy portfolio while fostering a culture of collaboration, continuous improvement, and customer success.
Your role in our mission- Provides executive leadership and strategic direction for Gainwell's Medicaid Pharmacy Administration and Technology product portfolio, serving as the senior advisor on pharmacy administration, pharmacy technology, and Medicaid pharmacy policy.
- Leads strategy and execution for enterprise pharmacy solutions including pharmacy claims processing, POS adjudication, clinical edits, prior authorization, drug utilization review (DUR), preferred drug lists (PDLs), supplemental rebates, pharmacy benefit management (PBM) capabilities, pharmacy analytics, and emerging interoperability initiatives supporting state Medicaid programs.
- Partners closely with state Medicaid agencies, executive client leadership, pharmacy directors, CMS stakeholders, clinical teams, and technology organizations to develop innovative solutions that improve beneficiary outcomes, enhance provider experience, strengthen program integrity, and reduce overall pharmacy program costs.
- Drives modernization of Gainwell's pharmacy technology platforms through cloud transformation, automation, API-enabled interoperability, FHIR standards, data analytics, AI-enabled decision support, and scalable product architecture that supports evolving Medicaid requirements.
- Directs the successful delivery and implementation of pharmacy administration solutions across multiple Medicaid clients while ensuring consistent execution, operational excellence, regulatory compliance, and high client satisfaction.
- Serves as the executive sponsor for strategic pharmacy initiatives, collaborating across Product Management, Engineering, Clinical Services, Operations, Sales, Account Management, Implementation, and Government Relations to deliver integrated pharmacy solutions.
- In partnership with Chief Core Platform and Product Operations Officer assumes accountability for the financial performance of the Medicaid Pharmacy product portfolio, including P&L management, investment strategy, revenue growth, margin improvement, pricing strategy, and long-term business planning.
- Develops business cases supporting strategic investments in pharmacy administration technologies, product modernization, acquisitions, partnerships, and innovation initiatives. Presents recommendations to executive leadership and oversees execution upon approval.
- Collaborates with Sales and Business Development organizations to support new business pursuits, proposal development, executive presentations, solution strategy, and client demonstrations related to Medicaid pharmacy technology.
- Builds strategic partnerships with pharmacy technology vendors, clinical partners, industry organizations, and strategic alliances to strengthen Gainwell's pharmacy ecosystem and expand market capabilities.
- Ensures all pharmacy products and services comply with applicable federal and state Medicaid regulations, CMS guidance, HIPAA, NCPDP standards, drug rebate requirements, pharmacy audit requirements, and contractual obligations.
What we're looking for- Twenty or more years of progressive leadership experience in healthcare technology, Medicaid, pharmacy administration, pharmacy benefit management (PBM), healthcare SaaS, or health information systems.
- Demonstrated executive experience leading Medicaid Pharmacy Administration products, pharmacy claims systems, PBM platforms, pharmacy operations, or state Medicaid pharmacy technology solutions.
- Deep knowledge of Medicaid pharmacy operations including pharmacy claims adjudication, NCPDP standards, POS processing, rebates, prior authorization, drug utilization review (DUR), preferred drug lists (PDLs), pharmacy provider management, and pharmacy benefit administration.
- Strong understanding of federal and state Medicaid regulations, CMS guidance, managed care pharmacy, fee-for-service pharmacy programs, and pharmacy program integrity.
- Experience defining enterprise product strategy, product lifecycle management, roadmap development, commercialization, and technology modernization within highly regulated healthcare environments.
- Experience leading digital transformation initiatives involving cloud technologies, APIs, interoperability, analytics, automation, and AI-enabled healthcare solutions.
- Fifteen or more years of executive leadership experience managing large cross-functional organizations.
- Experience working with Lean, Six Sigma, Agile product development, and continuous improvement methodologies.
- Experience managing complex P&Ls, investment planning, business case development, pricing strategy, and financial performance for large healthcare technology portfolios.
- Proven success building executive relationships with state Medicaid agencies, healthcare executives, technology partners, and industry organizations.
What you should expect in this role- This position is 100% remote with approximately 30% travel to support executive client meetings, state Medicaid agency engagements, industry conferences, and strategic planning sessions.
- Opportunity to lead one of the nation's largest Medicaid Pharmacy Administration technology portfolios serving millions of Medicaid beneficiaries across multiple states.
- Executive visibility with senior leadership and direct influence over Gainwell's pharmacy product strategy, innovation roadmap, and long-term market growth.
- Ability to shape the future of Medicaid pharmacy technology through modernization, digital transformation, interoperability, and innovative product development that improves healthcare outcomes for state Medicaid programs and their members.
The deadline to submit applications for this posting is October 6, 2026.
The pay range for this position is $168,000.00 - $240,000.00 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.
