Experienced Test Manager – PBM

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $90.9k - $129.9k / year

⏰ Full Time

🟠 Senior

🔴 Lead

👔 Manager

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Gainwell Technologies

WebsiteLinkedInAll Job Openings

10,000+ employees

💼 Consulting

📦 Logistics

⚕️ Healthcare Insurance

💰 Grant on 2023-06

Consulting • Logistics • Healthcare Insurance

Gainwell Technologies is the nation’s leading provider of digital and cloud-enabled solutions across the human services and public health ecosystem. With a mission-driven approach, Gainwell serves clients in all 50 U. S. states, focusing on improving health outcomes and delivering intuitive, human-centered experiences. Their comprehensive suite of solutions includes Medicaid Enterprise modernization, data analytics, provider services, and pharmacy solutions, all designed to advance the future of healthcare and enhance community well-being.

📋 Description

• Lead end-to-end pharmacy testing across SIT, UAT, Regression, and Parallel Testing for F6 transaction formats • Develop and manage test strategy, plans, schedules, and execution governance • Ensure alignment with compliance timelines and state Medicaid regulations • Validate and enforce NCPDP F6 transaction routing, data crosswalks, expanded product identifiers, and telephony compliance • Support the D.0 to F6 transition across 271 Eligibility Response and Formulary and Benefit outbound extracts • Oversee pharmacy functional validation, including claims adjudication, drug pricing, formulary management, prior authorization, DUR, COB, rebates, and pharmacy financial reconciliation • Manage defects and cross-functional coordination among business SMEs, PBMs, switch networks, vendors, developers, conversion teams, and onshore/offshore testing resources • Provide leadership reporting and sponsor-facing stakeholder communication by tracking quality metrics, risks, issues, and test progress

🎯 Requirements

• 10+ years of software testing experience • 5+ years of Test Management experience • Strong PBM or Medicaid pharmacy experience • Direct exposure to NCPDP standards transitions (D.0, F2, or F6) • Experience with large-scale DDI or MMIS modernization programs • Expertise in claims adjudication, NCPDP transactions, Prior Authorization, Formulary management, Drug Rebate processing, Eligibility (270/271) processing, and pharmacy financial validation • Experience using ALM/JIRA and SQL for data validation • Strong leadership, communication, and stakeholder management skills • Fully remote work limited to Contiguous US locations • Video cameras required during all interviews and the initial week of orientation

🏖️ Benefits

• Work flexibility • Learning and career development • Flexible vacation policy • 401(k) employer match • Comprehensive health benefits • Educational assistance • Leadership and technical development academies