Pharmacy Testing Manager (PBM/Medicaid)

Gainwell Technologies LLC; Oregon; Hybrid; USD 87,000 - 124,000; Full time

Benefits offered by this job

Remote work

401(k) employer match

Educational assistance

Job summary

Gainwell Technologies is seeking a Pharmacy Testing Manager (PBM/Medicaid) to lead end-to-end pharmacy testing across SIT, UAT, and production validation, ensuring quality delivery of PBM and Medicaid pharmacy solutions.

This remote, US-based role offers minimal travel and a strong focus on testing leadership, with opportunities to grow within a company that values flexibility, learning, and career development.

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.
• 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.

Responsibilities

• 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.

Skills

Software testing

Test management

PBM experience

Medicaid experience

Claims adjudication

NCPDP transactions

Prior Authorization

Formulary management

Drug rebate processing

Pharmacy financial validation

Tools

ALM/JIRA

SQL

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 Testing Manager (PBM/Medicaid) 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

The deadline to submit applications for this posting is November 15, 2026. 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.'