About this role
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.
Summary
As a Senior Business Analyst - Pharmacy 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.
We are seeking a highly skilled professional with strong experience in Pharmacy operations and Prior Authorization (PA) processes to support the configuration of automated PA rules within the PAE and Agadia platforms. The ideal candidate will possess a deep understanding of how pharmacy Prior Authorizations are initiated, reviewed, and adjudicated, and will be able to translate that knowledge into accurate rule configuration and workflow design.
Here are the details on this position.
Your role in our mission
Play a critical part in ensuring Gainwell is meeting our clients’ objectives in pharmacy benefit management (PBM) services.
- Support PBM or Drug rebate implementations and configurations
- Support PBM operations and maintenance on established accounts
- Work with a team of pharmacy clinicians and subject matter experts to configure the pharmacy systems to deliver services to our state clients.
- Assist in implementation of a pharmacy payer system.
- Perform Pharmacy updates including benefit plan design, edit/audit set up, utilization controls, PDL, configuration updates, and auto prior authorization parameters
- Be a knowledgeable bridge between operations staff, clients, project managers and technical staff to define, document and share pharmacy business requirements and expected impact
.... your role continued
- Work with the client to develop business rules and configuration requirements
- 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
- Testing point of sale (POS) pharmacy claims as required
- Exercise your ability to use basic analytical or relational database software — such as Excel or SQL — to quantify the anticipated impact of work
What we're looking for
- Six (6) or more years of experience in a relevant pharmacy business analyst or pharmacy technician position with 3 or more years of Medicaid and Medicare experience preferred
- Knowledge of computer programming concepts such as configuration, development, data conversion analysis and batch processing
- Pharmacy Experience as a Pharmacy Technician or working for a PBM
- Knowledge of drugs and drug file structures through FDB, Medispan, or Micromedex
- Knowledge the pharmacy payer process/claims processing.
- Experience working with drug file data or NCPDP guidelines
- Knowledge of prior authorization processes and criteria preferred
Additional skills
- Advanced knowledge in analytical software such as Microsoft Excel or SQL and other requirement-mapping tools such as Application Lifecycle Management (ALM) tools
- Strong client communication skills translating client needs to actionable objectives
- Strong analytical and business process re-engineering skills
- Strong executive presence and communication skills to deliver messages to business leaders, clients and technical personnel
- Good organization skills to balance work and prioritize tasks
- Ability to work independently with minimal supervision
What you should expect in this role
- Remote opportunity from Continental US locations only
- Possibility of up to 10% travel for client meetings/requirement review or implementations
- Video cameras must be used during all interviews, as well as during the initial week of orientation
- The deadline to submit applications for this posting is February 4, 2026
#LI-HC1
#LI-Pharmacy
#LI-PBM
#LI-NCPDP
#LI-Payer / Claims processing
#LI-POS testing
The pay range for this position is $64,900.00 - $92,700.00 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.
Other facts
About Gainwell Technologies LLC
For 50 years, our nation’s federal Medicaid program has worked to improve the health, safety and well-being of America’s most vulnerable populations: low-income families, women and children, seniors, and those with disabilities. With positive health and cost outcomes that pierce inequities and impact economies, the success of these programs is inextricably tied to the prosperity of communities, individual states and the nation as a whole. We think that demands respect and, more importantly, is deserving of a lifetime commitment from innovators who can help those who operate within and around health and human services evolve — in any market at any stage. At Gainwell Technologies, that’s our sole focus.
Built across more than five decades, Gainwell has intentionally seized opportunities to advance its digitally enabled services to meet agencies, health plans and MCOs where they are on their modernization journeys and propel them into the future of public health. Our commitment to innovation, deep experience and ability to leverage insights from customers across 50 states has allowed us to expand on next-generation, cloud-enabled technologies.
Today, Gainwell offers one of the most comprehensive suites of scalable services and solutions on the market — all proven to deliver cost savings, better patient outcomes and an improved provider experience. Equally important to our expanding technologies and results: We bring ideas that bring policies to life.
What you'll do
- The Senior Business Analyst - Pharmacy will support the configuration of automated Prior Authorization rules and ensure that Gainwell meets client objectives in pharmacy benefit management services. This role involves collaborating with pharmacy clinicians and subject matter experts to implement and maintain pharmacy systems.
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