Experienced Test Manager - PBM

Gainwell Technologies LLC•Any city, OH

12d•$90,900 - $129,900•Remote

About The Position

As an Experienced Test Manager - PBM (Pharmacy Benefit Manager) 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. This posting is intended for pipelining. This is a developing position therefore the job description is subject to change.

Requirements

10+ years of software testing experience.
5+ years of Test Management experience.
Strong PBM or Medicaid pharmacy experience, with 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, Pharmacy financial validation.
Experience using ALM/JIRA and SQL for data validation.
Strong leadership, communication, and stakeholder management skills.

Responsibilities

Lead end-to-end pharmacy testing across SIT, UAT, Regression, and Parallel Testing for F6 transaction formats, ensuring quality delivery of PBM and Medicaid pharmacy solutions.
Develop and manage test strategy, plans, schedules, and execution governance, ensuring alignment with compliance timelines and state Medicaid regulations.
Validate and enforce NCPDP F6 transaction routing, data crosswalks, expanded product identifiers, and telephony compliance, including 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 to ensure timely issue resolution.
Provide leadership reporting and sponsor-facing stakeholder communication by tracking quality metrics, risks, issues, and test progress.