Director, FWA, Pharmacy Network- Remote

Date: May 8, 2026

Location:

Any city, TX, US, 99999

Req ID: 35887

Work Mode: Virtual (Exception only)

It takes great medical minds to create powerful solutions that solve some of healthcare’s most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you’ve honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you’ll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development.

Summary

We are seeking a seasoned, strategic, and mission-driven Director to lead our Medicaid Fraud, Waste & Abuse (FWA) and Pharmacy Network Management functions. In this role, you will oversee program integrity operations, shape pharmacy network strategy, and lead high-performing teams dedicated to protecting Medicaid dollars while ensuring strong pharmacy access and provider accountability.

The ideal candidate brings deep Medicaid expertise, exceptional people leadership skills, and a passion for building compliant, data-driven, and operationally excellent programs. This leader directs multidisciplinary operations teams, partners closely with state Medicaid agencies, ensures adherence to federal and state regulations, and drives initiatives that strengthen program integrity and enhance member access, provider performance, and overall network value. The Director is responsible for setting strategy, managing people and processes, and delivering measurable results across both domains.

Your role in our mission

Lead the vision, strategy, and execution of Medicaid FWA and pharmacy network management programs
Drive initiatives that strengthen program integrity, optimize network performance, and meet state Medicaid expectations
Monitor industry trends, regulatory changes, and emerging fraud schemes to proactively evolve program strategy
Manage and develop managers, analysts, investigators, and network operations staff
Build a collaborative, high-performance culture with clear goals, coaching, and professional growth opportunities
Ensure teams operate with integrity, accountability, and operational excellence
Oversee FWA detection, investigation, prevention, and reporting activities
Guide the use of analytics, audits, and surveillance tools to identify high-risk providers and suspicious billing patterns
Ensure timely case management, documentation, referrals, and corrective action plans
Partner with state agencies, law enforcement, and internal compliance teams on FWA matters
Direct the strategy, performance, and compliance of the Medicaid pharmacy network
Oversee contracting, credentialing, reimbursement methodologies, and network adequacy
Monitor pharmacy performance metrics and lead initiatives to improve access, quality, and cost-effectiveness
Address high-risk pharmacy behavior and support provider education and engagement
Serve as a primary liaison with state Medicaid agencies and regulatory bodies
Ensure accurate and timely submission of required reports, audits, and corrective action plans
Translate regulatory requirements into operational processes and team workflows
Establish KPIs, dashboards, and reporting to track FWA outcomes and network performance
Lead process improvements to enhance efficiency, accuracy, and compliance
Oversee vendor relationships supporting FWA analytics, SIU functions, and credentialing
Manage budgets, resource planning, and ROI analysis for program initiatives

What we're looking for

Advanced degree or significant related experience
10+ years of pharmacy-related experience
Extensive experience in Medicaid program integrity, FWA operations, pharmacy network management, or related healthcare regulatory fields
Experience interacting with clients in the healthcare industry
Track record of cross-functional leadership of teams and projects spanning people, process, and technology
Excellent communication skills, with the ability to communicate externally and with senior executives
Innovative forward thinker with excellent leadership skills
Proven success leading teams and developing leaders
Strong understanding of Medicaid regulations, pharmacy operations, and provider network dynamics
Ability to build relationships with regulators, providers, and internal stakeholders
Strategic mindset with the ability to execute in a fast-paced, highly regulated environment

What you should expect in this role

This position is 100% remote within the US
Approximately 20% of travel to support key client meetings

This posting is intended for pipelining purposes and will remain open to accept applications on an ongoing basis.

The pay range for this position is $127,400.00 - $180,000.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You’ll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits, and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.

We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You’ll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.

Gainwell Technologies is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Gainwell Technologies defines “wages” and “wage rates” to include “all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.