Remote PBM/Medicaid Pharmacy Testing Manager

Gainwell Technologies; Texas City (TX); Remote; USD 87,000 - 124,000; Full time

Benefits offered by this job

Fully remote

401(k) match

Health benefits

Educational assistance

Job summary

Gainwell Technologies is seeking a Pharmacy Testing Manager (PBM/Medicaid) to lead end-to-end testing and validation of PBM and Medicaid pharmacy solutions. This fully remote role requires strong testing leadership, a deep PBM/Medicaid background, and experience with large-scale modernization programs.

You will develop test strategies, manage schedules, and oversee validation of claims adjudication, pricing, formulary management, prior authorization, rebates, and NCPDP transactions while

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/Medicaid domain

Large-scale program experience

Data validation

Tools

ALM/JIRA

SQL

Job description

Gainwell Technologies is seeking a Pharmacy Testing Manager (PBM/Medicaid) to lead end-to-end testing and validation of PBM and Medicaid pharmacy solutions. This fully remote role requires strong testing leadership, a deep PBM/Medicaid background, and experience with large-scale modernization programs.

You will develop test strategies, manage schedules, and oversee validation of claims adjudication, pricing, formulary management, prior authorization, rebates, and NCPDP transactions while