Remote Pharmacy Testing Manager, PBM/Medicaid

Gainwell Technologies LLC; North Carolina; Remote; USD 87,000 - 124,000; Full time

Benefits offered by this job

Fully remote

401(k) employer match

Health benefits

Educational assistance

Leadership and technical development

Job summary

Gainwell Technologies LLC in the United States is seeking a Pharmacy Testing Manager (PBM/Medicaid) to lead end-to-end testing across SIT, UAT, Regression, and Production Validation for PBM and Medicaid pharmacy solutions. You will develop test strategy, plans, and governance.

The role requires 10+ years of software testing and 5+ years of test management with strong PBM/Medicaid pharmacy expertise, and proficiency in ALM/JIRA and SQL for data validation.

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 pharmacy

DDI/MMIS modernization

Claims adjudication

NCPDP transactions

Prior Authorization

Formulary management

Drug rebate processing

Pharmacy financial validation

Tools

ALM/JIRA

SQL

Job description

Gainwell Technologies LLC in the United States is seeking a Pharmacy Testing Manager (PBM/Medicaid) to lead end-to-end testing across SIT, UAT, Regression, and Production Validation for PBM and Medicaid pharmacy solutions. You will develop test strategy, plans, and governance.

The role requires 10+ years of software testing and 5+ years of test management with strong PBM/Medicaid pharmacy expertise, and proficiency in ALM/JIRA and SQL for data validation.