[Hiring] Vice President, Rx General Manager @Gainwell Technologies LLC

Role Description

Drives the vision, strategy, growth, and execution of Gainwell's Medicaid Pharmacy Administration and Technology portfolio, including:

• Pharmacy benefit administration
• Claims processing
• Clinical and utilization management solutions
• Rebate management
• Preferred drug list (PDL) management
• Point-of-sale (POS) adjudication
• Pharmacy network management
• Interoperability
• Emerging pharmacy technologies

Leads the development and execution of product strategy that aligns with:

• Federal and state Medicaid policy
• CMS regulations
• Evolving market needs

Ensures attainment of the organization's financial, operational, and strategic business objectives.

Develops and expands Gainwell's market leadership in Medicaid pharmacy technology by:

• Building trusted relationships with state Medicaid agencies, industry partners, and executive stakeholders
• Championing innovation, product modernization, digital transformation, and operational excellence
• Fostering a culture of collaboration, continuous improvement, and customer success

Qualifications

• Twenty or more years of progressive leadership experience in healthcare technology, Medicaid, pharmacy administration, pharmacy benefit management (PBM), healthcare SaaS, or health information systems
• Demonstrated executive experience leading Medicaid Pharmacy Administration products, pharmacy claims systems, PBM platforms, pharmacy operations, or state Medicaid pharmacy technology solutions
• Deep knowledge of Medicaid pharmacy operations including pharmacy claims adjudication, NCPDP standards, POS processing, rebates, prior authorization, drug utilization review (DUR), preferred drug lists (PDLs), pharmacy provider management, and pharmacy benefit administration
• Strong understanding of federal and state Medicaid regulations, CMS guidance, managed care pharmacy, fee-for-service pharmacy programs, and pharmacy program integrity
• Experience defining enterprise product strategy, product lifecycle management, roadmap development, commercialization, and technology modernization within highly regulated healthcare environments
• Experience leading digital transformation initiatives involving cloud technologies, APIs, interoperability, analytics, automation, and AI-enabled healthcare solutions
• Fifteen or more years of executive leadership experience managing large cross-functional organizations
• Experience working with Lean, Six Sigma, Agile product development, and continuous improvement methodologies
• Experience managing complex P&Ls, investment planning, business case development, pricing strategy, and financial performance for large healthcare technology portfolios
• Proven success building executive relationships with state Medicaid agencies, healthcare executives, technology partners, and industry organizations

Requirements

• Provides executive leadership and strategic direction for Gainwell's Medicaid Pharmacy Administration and Technology product portfolio
• Leads strategy and execution for enterprise pharmacy solutions including pharmacy claims processing, POS adjudication, clinical edits, prior authorization, drug utilization review (DUR), preferred drug lists (PDLs), supplemental rebates, pharmacy benefit management (PBM) capabilities, pharmacy analytics, and emerging interoperability initiatives
• Partners closely with state Medicaid agencies, executive client leadership, pharmacy directors, CMS stakeholders, clinical teams, and technology organizations
• Drives modernization of Gainwell's pharmacy technology platforms through cloud transformation, automation, API-enabled interoperability, FHIR standards, data analytics, AI-enabled decision support, and scalable product architecture
• Directs the successful delivery and implementation of pharmacy administration solutions across multiple Medicaid clients
• Serves as the executive sponsor for strategic pharmacy initiatives
• In partnership with Chief Core Platform and Product Operations Officer, assumes accountability for the financial performance of the Medicaid Pharmacy product portfolio
• Develops business cases supporting strategic investments in pharmacy administration technologies
• Collaborates with Sales and Business Development organizations to support new business pursuits
• Builds strategic partnerships with pharmacy technology vendors, clinical partners, industry organizations, and strategic alliances
• Ensures all pharmacy products and services comply with applicable federal and state Medicaid regulations

Benefits

• 100% remote position with approximately 30% travel
• Opportunity to lead one of the nation's largest Medicaid Pharmacy Administration technology portfolios
• Executive visibility with senior leadership
• Ability to shape the future of Medicaid pharmacy technology
• Generous, flexible vacation policy
• 401(k) employer match
• Comprehensive health benefits
• Educational assistance
• Leadership and technical development academies