Gainwell Technologies

Pharmacist

• Serve as the primary clinical SME on pharmacy implementations
• Lead clinical and drug reference domains on pharmacy design, development, and implementations (DDIs)
• Be a primary point of contact with the state client pharmacy team during the DDI and hypercare phases
• Ensure benefit plan drug coverages are configured accurately to state client specifications and requirements
• Validate successful and accurate conversion of pharmacy data from other vendors and stakeholders
• Ensure all point‑of‑sale (POS) claims processing edits, pricing, return messaging, and configuration meet the business requirements of the client
• Work with engineering and pharmacy business analyst teams to configure automated PA rule sets and electronic prior authorization (EPA) question sets, including testing scenarios and validation with the client
• Track and document progress of clinical domain activities against requirements and timelines, and provide status reports to senior leaders
• Identify risks or issues, ensure they are documented and tracked, and work with appropriate stakeholders to resolve them
• Maintain a clear understanding of the operational readiness, certification, and delivery status of all Gainwell pharmacy implementations
• Provide subject matter expertise for pharmacy and drug rebate product development, sales pursuits, RFP responses, and DDIs
• Encourage and strengthen cohesiveness and team unity across the pharmacy business and stakeholders on all Gainwell pharmacy implementations
• Participate in corporate pharmacy team meetings

PBM Implementation Pharmacist

Business Analyst

• Play a critical part in ensuring Gainwell is meeting our clients’ objectives in important areas.
• Help coordinate a business analyst team’s duties and activities on IT projects and nurture newer team members by providing guidance and support.
• Be a knowledgeable bridge between clients, project managers, and technical staff to define, document, and share business requirements and expected impact.
• Work with the client to develop business specs at the start of a technical project.
• Analyze, plan, design, document or make recommendations to improve business processes to support client’s technology goals.
• Help verify that all requirements have been met by approving and validating test results.

Senior Business Analyst – Benefit Plan Administration

Analyst

• Help create the power in Gainwell’s processes as we develop purpose-built technologies and solutions that yield better health and human services outcomes.
• Share your expertise as you support the Business Process Services team in claims processing that adheres to policy guidelines.
• Meet production and quality requirements established by clients for timely claims processing.
• Use policy guidelines and criteria established by leadership to evaluate why a claim errored and make an adjudication decision.

Provider Enrollment Analyst

Call Center Representative

• Answer incoming calls promptly and professionally, addressing member or provider inquiries, and make outbound calls as needed.
• Ability to remain calm and professional in high-pressure situations.
• Accurately document all interactions in the system, ensuring records are updated and complete.
• Maintain confidentiality and comply with HIPAA and other healthcare regulations.
• Escalate complex issues to supervisors or appropriate departments when necessary.
• Meet or exceed performance metrics including adhering to standardized call scripting and quality guidelines, call handle time, customer satisfaction and adhere to a daily work, lunch and break schedule.

Healthcare Contact Center Agent

Operations

• Manage proposal production and operational processes while providing editorial support and work planning assistance on an as-needed basis throughout the pursuit lifecycle.
• Maintain and update standard proposal templates, production procedures, style guides, and operational documentation to promote consistency across proposal workflows.
• Manage the day-to-day relationship with the Gainwell Printing Services Provider and oversee proposal production activities for printed submissions to support timely and accurate proposal delivery.
• Support implementation and maintenance of AI-enabled tools and technologies to enhance proposal efficiency, quality, and operational effectiveness.
• Assist leadership with metrics tracking and reporting, process improvement initiatives, and lessons learned activities to support continuous improvement and operational scalability.
• Provide editorial, document formatting, and quality assurance support, as needed, to include creating shell files, formatting and maintaining resumes, managing RFP-specific conventions lists, and performing editing, proofreading, and quality reviews to promote consistency, clarity, responsiveness, compliance, and overall proposal quality.
• Develop integrated work plans, using Microsoft Project and related planning tools, as needed, including milestones, task dependencies, review cycles, and production timelines.

Proposal Operations Specialist

• Partners with Pharmacy executive team to drive business strategy and business development through insights and analysis
• Overall responsibility for Pharmacy program design, development, execution and performance
• Market surveillance, understanding of market demands and client pain points to ensure robust and competitive offering of Pharmacy programs, services, and solutions
• Provides analysis of financial performance, pharmacy business growth forecasts, business pipeline projections, and new solution value modeling
• Partners with VP of Growth, State Sector Leaders, and Account General Managers for analysis of bid pipeline and development of state strategies
• Supports state needs through RFP and bid proposals in support of the Pharmacy Center of Excellence organization
• Aligns proposal requirements to business execution plans
• Manages and optimizes vendor contracts
• Drives key initiatives in support of strategy, pharmacy growth, and business development
• Reports status of key initiatives and aligns resources across the organization for delivery of key strategies
• Supports executive team in development of growth plans and market strategies
• Drives development of strategy materials and presentations
• Drives analysis in support of business development projects and senior leadership key initiatives
• Supports analysis for Pharmacy segment P&L management
• Supports Pharmacy executive team on Rx cost optimization strategies
• Delivers analysis and support for business cases for new investments
• Helps drive 3rd party business development
• Leads industry relations and partnerships in support of GainwellRx
• Serves as an industry expert on GainwellRx, interfacing with external clients, vendors, and business partners
• Collaborates across account teams, sales teams, product teams, and other shared service functions
• Drives new ideas, partners with states on new concepts, and works with teams to deliver models to support them

Director, Pharmacy Strategy

• Support enterprise content and document management initiatives by performing a dual role as a Business Analyst and Data Analyst.
• Work closely with business stakeholders, clients, and technical teams to gather requirements, analyze data, and map end-to-end solutions within the C3M, FileNet, and CMOD domain.
• Elicit and document business and functional requirements, validating change requests, and ensure appropriate testing strategies and implementation plans are in place.
• Audit solution changes to ensure quality, compliance, and operational readiness.

Business Analyst – Content & Document Management, Infra

Program Manager

• Responsible for overall service delivery and satisfaction of assigned clients
• Achieving revenue and margin goals
• Ensuring quality and timeliness of client deliverables
• Identifying and assisting with development and execution of sales strategies
• Facilitating growth of professional staff
• Building and enhancing client relationships
• Supporting and/or leading corporate initiatives
• Driving overall HMS agenda within assigned commercial clients

Senior Director, Program Management

• Work collaboratively with the client and team members
• Research, validate and document business needs
• Ensure items are prepared for client meetings
• Assist with translating client requests
• Document updates for all reference updates/changes
• Work with the systems team on assigned system changes
• Assist with quarterly and annual CPT, HCPCS and diagnosis code updates

Business Analyst – Healthcare

• Conduct evidence‑based evaluations of drugs and drug classes using accepted clinical methodologies
• Develop and maintain Gainwell TCRs to support recommendations for Preferred Drug List (PDL) management
• Apply evidence‑based medicine principles to develop clinical PA recommendations and supporting documentation
• Review clinical and pricing data to support the Gainwell clinical PDL team
• Review and monitor prescription claims data and prescribing patterns identified as outliers
• Contribute to the development of Clinical Services publications produced on a weekly, monthly, quarterly, and as‑needed basis
• Support continuous quality improvement by identifying enhancement opportunities
• Provide support to client accounts during implementation, maintenance, and ongoing operations
• Promote collaboration and alignment across the pharmacy business

Clinical Pharmacist

Account Executive

• Serve as the primary executive point of contact for state Medicaid clients, including Pharmacy Directors and senior leadership.
• Build and maintain strong client relationships, acting as a trusted advisor on all aspects of the Medicaid pharmacy benefit.
• Provide comprehensive oversight of pharmacy clinical operations, including prior authorization and utilization management.
• Develop and execute account strategies aligned with organizational and client goals.
• Own account‑level financial performance, including cost‑of‑care outcomes and budget alignment.
• Lead, mentor, and develop a team of account managers, clinical leaders, and operations staff.

Pharmacy Account Director

Software Engineer

• Design and deliver complex, comprehensive product-based business solutions
• Lead or monitor the product implementation process
• Provide strategic product advice to clients
• Be a knowledge expert in emerging technologies
• Manage and motivate a team of product development experts

Product Developer

Data Engineer

• Assist in building and maintaining data pipelines for ingesting, transforming, and loading data
• Support ETL/ELT processes for structured and unstructured data sources
• Work with engineers to troubleshoot and improve pipeline performance
• Write and optimize SQL queries for data extraction and transformation
• Perform data cleansing, validation, and basic transformations
• Support development of reusable data components and scripts
• Assist in managing and monitoring data workflows in cloud environments (AWS, Cloudera, etc.)
• Support execution and scheduling of batch and real-time data jobs
• Help maintain development, test, and production environments
• Perform basic data validation and quality checks
• Document data flows, pipelines, and transformations
• Support adherence to data governance and security standards
• Work with cross-functional teams (engineering, analytics, product) to understand data requirements
• Participate in code reviews, team discussions, and agile ceremonies
• Continuously learn new tools, technologies, and best practices in data engineering

Architect

• 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
• The principal role of the PAI architect is to be a liaison between the customer and our Abacus partners
• Ensure the end-to-end solution for each client/project is fully supported with no gaps
• Technical project documentation – Creating state specific artifacts such as ADDs, RTMs, data flow diagrams, project guides
• Support go-live activities – ensure that documents are completed and approved
• Security documentation and approvals – ensure that we have the most current Abacus generated security reports
• Coordinate the definition of state specific business rules - work with Abacus and state resources to define and resolve anomalies found during data ingestion
• SFTP/MFT implementation - ensure that these connections are established, documented, and supported
• SharePoint management – manage SharePoint sites to help share PHI and non-PHI document with our external vendors
• Problem resolution and issue management – support our solution with unanticipated one-off requests

Application Architect

Data Scientist

• Designs, develops, programs methods, processes and systems to consolidate and analyze unstructured, diverse big data sources using machine learning and predictive modeling tools.
• Builds analytic models to identify and quantify solutions to business problems.
• Interprets and communicates insights and findings from analysis and experiments to client, service, and business managers.
• Provides leadership and work guidance to less experienced personnel towards build of software programs, algorithms and automated processes to cleanse, integrate and evaluate large datasets from multiple disparate sources.
• Champions global initiatives in data sciences.