Gainwell Technologies

AI Engineer

• Provides design documents and translates them into component-level designs to accelerate development
• Provides design expertise supporting development teams with flexible, reusable components
• Analyzes, designs, and reviews applications to ensure customer specifications are satisfied
• Liaises between application architects and development teams to coordinate product development and implementation
• Develops accurate and relevant design requirements with product development teams and senior designers
• Reviews technical research and evaluates tools and methodologies against industry, client, and company standards
• Develops technical documentation and participates in test-plan development, integration, and deployment
• Participates in business process work sessions, project meetings, and joint application development sessions
• Acts as a domain expert and explains application design to software developers
• Coordinates application design activities to enhance product quality and efficiency
• Defines and develops project requirements, functional specifications, and detailed application solution designs
• Provides leadership and work guidance to less experienced personnel and developers

Financial Planning and Analysis

• Oversee the financial health of the Customer Experience organization
• Manage annual budgeting and monthly forecasting processes
• Interpret, summarize, and upload financial information to financial systems
• Prepare presentations supporting business decisions and communicate with management, finance leadership, and the corporate office
• Perform complex financial analyses, including budgeting, trend analysis, forecasting, and financial modeling
• Develop and maintain headcount models
• Review journal entries to meet business needs
• Monitor division and department adherence to approved budgets
• Coordinate, compile, and present monthly variance analyses with conclusions to management
• Make recommendations for financial planning, process changes, and procedural improvements
• Document and regularly review and update processes and procedures
• Provide guidance on process improvements aligned with business tactics and strategy
• Perform other duties as assigned

Senior Manager, Finance

Pharmacist

• Handle inbound and outbound calls related to prior authorization requests and provider inquiries
• Accurately process and document prior authorization requests within required timeframes
• Provide courteous and knowledgeable support to healthcare providers across phone, email, fax, and web
• Ensure all communications and data handling comply with HIPAA and internal confidentiality protocols
• Collaborate with cross-functional teams to resolve issues and improve service delivery
• Support Gainwell’s pharmacy benefit management services by managing provider inquiries and prior authorizations

Prior Authorization Pharmacy Technician

Supervisor

• Oversee daily quality assurance activities and prioritize team workload
• Ensure consistent delivery of high-quality results meeting organizational and client expectations
• Identify quality trends and analyze performance data
• Implement process improvements to enhance efficiency, accuracy, and service delivery
• Recruit, train, mentor, and evaluate employees
• Foster accountability, collaboration, and continuous learning
• Lead internal audit activities and conduct quality reviews
• Ensure adherence to quality management standards, testing methodologies, operational requirements, policies, and procedures
• Partner with cross-functional stakeholders on process development, technology implementations, testing, and service improvement initiatives
• Monitor and evaluate voice and non-voice interactions for accuracy, compliance, and experience
• Conduct daily reviews and audits of calls, transactions, and related business processes

CX Quality Supervisor

Customer Support

• Contribute to the CX DDI Mobilization team and support client contact center launch efforts
• Serve as a bridge between stakeholders, project managers, and clients
• Verify CX-specific requirements are identified and documented
• Detail how requirements are met through HRM and capture impacts, timelines, risks, and issues
• Analyze, plan, outline, document, and recommend improvements to business processes supporting CX goals
• Communicate business messages and ideas to leaders, stakeholders, team members, and clients
• Motivate others to action and communicate key business ideas clearly
• Develop integrated business requirements documents across multiple organizations
• Facilitate requirements gathering and create deliverable documentation and RTM materials
• Support CX RFP completion and create CX reports such as Feedback Survey and inSight Reports
• Perform deep-dive variance analyses comparing actual expenditures and revenues against budgets and forecasts
• Identify cost and staffing overruns or schedule delays using CV and CPI metrics
• Partner with cross-functional project leads on corrective actions
• Lead budgeting and re-forecasting cycles for assigned project portfolios

Customer Experience Mobilization – PM/BA, Financial

• Serve as a critical contributor ensuring Gainwell meets client objectives
• Act as a knowledgeable bridge between stakeholders, project managers, and clients
• Verify CX-specific requirements are identified and documented
• Detail how requirements are met (HRM) and capture impacts, timelines, risks, and issues
• Analyze, plan, outline, document, or recommend improvements to business processes supporting CX goals
• Deliver messages to business leaders, stakeholders, team members, and clients
• Motivate others to action and communicate key business ideas in a digestible way
• Develop integrated business requirements documents (BRDs) across multiple organizations
• Facilitate requirements gathering and create deliverable documentation and Requirements Traceability Management (RTM)
• Support CX RFP completion
• Support client contact center launch efforts for the CX DDI Mobilization team

Customer Experience Mobilization – PM/BA

Software Engineer

• Provide senior technical leadership for secure, scalable applications supporting Medicaid DDI and modernized Provider Plus delivery
• Lead application design and implementation standards across React/TypeScript, .NET 10/C#, APIs, data, integrations and AWS workloads
• Review complex designs, code, test evidence and technical specifications
• Resolve defects, performance issues and production risks
• Guide multi-tenant architecture, configuration-driven behavior, feature flags, versioning and compatibility with legacy interfaces
• Guide PostgreSQL modeling, conversion/reconciliation, REST and event-driven integrations, Glue/Spark batch workloads and Kafka/MSK patterns
• Establish Terraform, CI/CD, automated quality gates, observability, secure logging, vulnerability remediation and release controls
• Mentor engineers and communicate technical decisions, risks, tradeoffs and recommendations across product and DDI teams
• Travel as required (0-10%)

Product Developer

Project Manager

• Strengthen the quality and smooth running of important projects
• Lead one or more medium-sized project management teams by overseeing smaller aspects of a larger technological program
• Contribute directly to projects
• Assist in staffing and oversee assigned staff by providing direction and deadlines
• Interface with the client, company and project team leadership
• Measure and communicate project metrics and recommend program changes
• Drive the quality of project deliverables across all phases of the program
• Create objectives, schedules, program definitions and budgets
• Identify and mitigate risk through status reporting and project updates
• Prepare detailed SOWs for clients and obtain stakeholder agreement and approval on scope

Senior Project Manager

Business Analyst

• Analyze, plan, design, document and make recommendations to improve business processes supporting client technological aspirations
• Bridge clients, project managers and technical personnel to define, track and communicate business requirements and expected impact
• Build basic conceptual data and process models
• Create, execute or analyze basic test scenarios to verify client requirements are incorporated into system design
• Participate in technical reviews and inspections to ensure the intent of change is carried out through every project phase

Vice President

• Drive the vision, strategy, growth, and execution of Gainwell's Medicaid Pharmacy Administration and Technology portfolio
• Provide executive leadership and strategic direction for the Medicaid Pharmacy Administration and Technology product portfolio
• Lead strategy and execution for enterprise pharmacy solutions including claims processing, POS adjudication, clinical edits, prior authorization, DUR, PDLs, supplemental rebates, PBM capabilities, analytics, and interoperability initiatives
• Partner with state Medicaid agencies, executive client leadership, pharmacy directors, CMS stakeholders, clinical teams, and technology organizations
• Drive modernization through cloud transformation, automation, API-enabled interoperability, FHIR standards, data analytics, AI-enabled decision support, and scalable product architecture
• Direct delivery and implementation of pharmacy administration solutions across multiple Medicaid clients
• Serve as executive sponsor for strategic pharmacy initiatives across Product Management, Engineering, Clinical Services, Operations, Sales, Account Management, Implementation, and Government Relations
• Manage P&L, investment strategy, revenue growth, margin improvement, pricing strategy, and long-term business planning for the Medicaid Pharmacy product portfolio
• Develop business cases for strategic investments, modernization, acquisitions, partnerships, and innovation initiatives; present recommendations to executive leadership and oversee execution
• Support new business pursuits, proposal development, executive presentations, solution strategy, and client demonstrations
• Build strategic partnerships with pharmacy technology vendors, clinical partners, industry organizations, and strategic alliances
• Ensure compliance with Medicaid regulations, CMS guidance, HIPAA, NCPDP standards, drug rebate requirements, pharmacy audit requirements, and contractual obligations

Vice President, General Manager

Database Administrator

• Lead client and project engagements to assess requirements and define database design strategies
• Analyze user needs and develop technical specifications ensuring performance, security, and data integrity
• Design, develop, implement, and maintain database solutions
• Automate data processes and reporting capabilities
• Monitor and optimize database performance
• Manage production support activities, including backup/recovery and archiving
• Implement database standards
• Maintain documentation and evaluate emerging technologies
• Provide guidance to junior team members
• Support critical healthcare operations and data-driven decision-making

IT Support

• Serve as the first point of contact for healthcare providers by answering inbound calls and responding to EDI and provider-related inquiries
• Research, troubleshoot, and resolve provider issues, escalating more complex concerns to the appropriate teams when needed
• Conduct outbound follow-up calls and communications to ensure timely resolution of provider requests
• Process provider and member updates while maintaining accuracy, compliance, and documentation standards
• Meet established service, quality, and productivity goals while delivering professional and responsive customer support
• Support Montana Medicaid operations
• Help healthcare providers resolve questions and issues related to Electronic Data Interchange, provider services, and healthcare transactions

EDI Helpdesk Representative

Planner

• Support short- and long-term workforce forecasts across voice and non-voice channels
• Develop and maintain multi-channel forecasting models using historical workload trends, productivity metrics, staffing data, and business drivers
• Translate workload forecasts into staffing and capacity requirements, incorporating attrition, hiring plans, training throughput, productivity assumptions, and skill mix requirements
• Analyze workforce capacity versus demand to identify staffing gaps, operational risks, and optimization opportunities
• Support long-range capacity planning and scenario modeling
• Evaluate forecast accuracy, identify variance drivers, and recommend improvements
• Provide workforce planning recommendations on hiring, cross-training, scheduling, workload balancing, overtime, and resource allocation
• Partner with Operations, Finance, Training, Reporting, and global delivery teams
• Translate complex workforce planning data into actionable insights
• Use Verint, Excel, Power BI, and workforce management tools for forecasting, planning, reporting, and optimization

Omni-Channel Workforce Management Capacity Planner

Manager

• Supervise day-to-day prepay, post-pay, prior authorization, and medical record review activities of Coders, Clinical DRG Auditors, and Nurse Reviewers
• Lead the team, assign work, and ensure productivity and quality metrics are achieved
• Analyze production and workflow processes to increase efficiency and quality
• Communicate changes, build commitment, overcome resistance, support affected staff, and monitor transitions
• Oversee and hire staff, retain talent, manage performance, coordinate training and education, and provide leadership and mentorship
• Monitor aging inventory, workload, assignments, productivity, and quality against service-level agreements, contract deliverables, and timelines
• Evaluate productivity, utilization, efficiency, finding rates, savings, appeal overturn rates, and completed reviews
• Meet with clients and providers regarding complex cases, trend analysis, exit conferences, and settlement conferences
• Serve as a subject matter expert for new tools, automation, product development, and clinical readiness
• Resolve escalated issues and coach and mentor staff
• Analyze reports and data to identify trends and resources that improve clinical review service delivery
• Manage and evaluate individual and team performance and take action to meet or exceed standards
• Perform other assigned functions

Associate Manager, Clinical Claim Review

• Design, develop, maintain, and support complex batch processing applications in Linux and Unix environments
• Provide technical leadership, mentor developers, guide solution design, conduct code reviews, and support all SDLC phases
• Collaborate with business analysts, architects, quality assurance teams, and stakeholders to translate requirements into technical solutions
• Analyze, troubleshoot, and resolve complex application and database issues using SQL Server and/or Oracle
• Perform root cause analysis and implement corrective actions to improve system performance and stability
• Support change management, release planning, production deployments, and continuous improvement initiatives
• Drive modernization through automation, cloud technologies, and DevOps best practices
• Contribute to Medicaid healthcare systems, including claims processing, reference systems, PBM, Drug Rebate, ProdDur, batch processing environments, and other critical healthcare applications
• Develop and maintain technical documentation, process flows, and support materials