Pharmacy Benefit Management Solution Architect

Summary

Gainwell Technologies provides pharmacy management services for 19 State Medicaid Fee for Service (FFS) programs.  

We deliver: 

• Pharmacy Point of Sale (POS) claims module to accurately process claims and encounters, to perform drug utilization review, and to perform automated prior authorization services according to the State Medicaid program requirements.  
   
• The CMS-certified solution enables rapid deployment of program and policy changes as they occur throughout the course of the contract.  It is fully integrated with the State’s internal solutions and other trading partners, using the latest technology and automated processes for routine data exchange.  
   
• The solution is in compliance with HIPAA privacy and security guidelines, NIST guidelines, and other State and Federal laws, rules, and guidelines.
   
• The POS claims module is utilized by the Gainwell call centers to support prescribers, pharmacies, and members in the administration of the State Medicaid pharmacy benefits, including drug prior authorization.
   
• Rebate Administration via a cloud-based solution to invoice, collect, and reconcile manufacturer rebate payments predominantly for the Medicaid Drug Rebate Program (MDRP), but may include other federal and state pharmacy sponsored programs.
   
• Preferred Drug List Management via negotiation with drug manufacturers on behalf of our state clients and the development and delivery of formulary and prior authorization recommendations to ensure member access to safe and effective therapies.

Your role in our mission

•    Assesses Gainwell’s existing pharmacy benefit management solution and environment and analyzes technologies and software changes to provide the best solution to meet emerging market needs.   

•    Design/manage an architecture roadmap to achieve alignment with the MITA (Medicaid Information Technology Architecture) framework, as defined by CMS and required by State guidelines.  The roadmap is critical to support contract compliance and to meet Federal funding requirements for State Medicaid customers.  Work with Sales, Product Management, Clinical, and Account leaders to identify market trends for strategic features / functions and collaborate to develop a product roadmap that ensures the solution offering remains competitive.  This includes the articulation of a strategic vision for technical architecture and development pipeline, budget determination for software development and hosting, and monitoring progress in delivering the solution.  

•    The Pharmacy Solution Architect helps bridge the clinical / analytic needs of our non-technical pharmacy staff with the IT and infrastructure subject matter experts. The Pharmacy Solution Architect is the liaison to define cost-effective solutions that improve pharmacy benefit management functionality.
 

•    Provide recommendations and roadmaps for proposed pharmacy benefits management solutions.

•    Support the technical resources to mature discipline with focus on service-oriented architecture (SOA), and to deliver a modular, interoperable pharmacy solution in alignment with industry and regulatory standard.  

•    Consistently evaluate and implement open-source tools, leveraging industry leading products to meet key business requirements.  Identify opportunities to achieve savings by moving off legacy systems that have higher support costs.

•    Support RFPs by evaluating gaps between market demand and Gainwell solution capabilities.

•    Document and share best practice knowledge for new solutions.

•    Develop proof-of-concept projects to validate proposed solutions, as well as the technology ROI.

•    Provide technical leadership throughout the project lifecycle.

•    Reviewing and validating solutions designs from another team.  Perform design, debug, and performance analysis on pharmacy solutions.

•    Advocate for process improvements and help implement the improvements including relevant documentation.

•    Regularly communicate new features and benefits to partners, customers, and other internal and external stakeholders at the leadership level.

•    Working knowledge of Azure Dev Ops to enter and track work tickets for product development. 

•    Knowledge of Agile and Waterfall delivery models.
 

What we're looking for

• 7 years’ experience in pharmacy engineering and software design
   
• In-depth understanding of technology software and coding languages
   
• In-depth pharmacy domain expertise – including transaction standards (NCPDP), reference database elements and structures, switch vendors and trading partners.
   
• Must be well versed in CMS guidance and Federal legislation that govern pharmacy administration and operations in the public sector.
   
• Prior project management experience leading large-scale projects, with routine, direct interaction with the client, trading partners, and internal staff.
   
• Web Portal experience / expertise

What you should expect in this role

• Fully remote opportunity with the option to work anywhere within the United States