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Pharmacy Benefit Management Solution Architect

Date:  Sep 17, 2023

Any city, TX, US, 99999

Req ID:  17747

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. Working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work flexibility, learning, and career development. You’ll add to your technical credentials and certifications while enjoying a generous, flexible vacation policy and educational assistance. We also have comprehensive leadership and technical development academies to help build your skills and capabilities.



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.

•    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 


The pay range for this position is $108,500.00 - $155,000.00 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 committed to a diverse, equitable, and inclusive workplace. We are proud to be 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), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. We celebrate diversity and are dedicated to creating an inclusive environment for all employees.

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