Test Lead, Manual Test, US Healthcare, Medicaid, Pharmacy
Location
India
Posted
10 days ago
Salary
0
Seniority
Senior
Job Description
Test Lead, Manual Test, US Healthcare, Medicaid, Pharmacy
Gainwell Technologies
• Perform vital testing, troubleshooting and analysis of application software for complex technical projects • Design, develop, implement, maintain and monitor critical test processes • Gather requirements for testing, develop executable test cases and help distribute workload across a team of test engineers • Coordinate and collaborate with others to analyze requirements to confirm, establish and communicate the defect-causing problem to the right stakeholders • Assist, as needed, in writing proposals to recommend process and programs • Help prepare estimates for performing the various activities defined in the test plan
Job Requirements
- 15+ years of overall experience
- 5+ years specifically in Medicaid pharmacy operations, MMIS/MES systems, PBM functions, or pharmacy claims processing
- Strong understanding of NDC, HCPCS, quantity limits, and drug pricing methodologies
- Strong understanding of Medicaid PDL, clinical PA criteria, DUR requirements
- Strong understanding of Pharmacy benefit administration and reimbursement models
- Hands‑on experience with EDI transactions (837, 835, 278)
- Experience with test management tools and SQL for data validation
- Familiarity with Gainwell, Conduent, Optum, Magellan, or other Medicaid pharmacy modules
Benefits
- Flexible work arrangements
Related Guides
Related Categories
Related Job Pages
More Pharmacist Jobs
Ambulatory Care Clinical Pharmacist – OH, MI, IL
Cityblock HealthBringing better care to communities where it's needed most.
• Provide Comprehensive Medication Management (CMM) in collaboration with hub-based and virtual clinical care teams and provide other pharmacist support services as needed. • Contribute in the development of a medication management action plan to achieve member self-management goals and clinical outcomes, with measurable parameters and timeline for monitoring and follow-up. • Communicate and work collaboratively with Cityblock and external providers belonging to member care team to ensure all clinical interventions and encounters are aligned with medication-related goals, and conduct ongoing assessments and refinements to care plan necessary to promote goal attainment. • Provide direct support to clinical team members for all general drug information, dosing, interaction/adverse effect avoidance questions or member-specific needs. • Participate in staff education through presentation of medication management in-services, development of educational tools for clinical and non-clinical team members, and training/coaching/facilitating all roles on consistent maintenance of a member’s best possible medication list care management platform, Commons, as well as post-discharge med reconciliation process for providers. • Help develop medication management and disease state-specific clinical pathways/protocols, with the eventual goal of transitioning to collaborative practice agreements (CPA) with Cityblock physicians, permitting pharmacist to perform member assessments, order laboratory tests, and initiate or adjust medications per protocol to improve the efficiency and effectiveness of team-based care.
Health Plan Pharmacist
Blue Cross Blue Shield of ArizonaInspiring Health in Arizona for over 80 years.
Role Description This position is responsible for maintaining and supporting the Medicare and/or Medicaid formulary and providing clinical and economic data necessary to make formulary decisions. This position acts as a pharmacy resource for network physicians, health plan members, medical services, care management, and member service staffs as well as other internal partners. Assists in performing all CMS mandated quality and compliance activities. Serves as a pharmacy topic educator and training resource to Medicare and/or Medicaid health plan departments and personnel. This position has the latitude for independent decision-making within the limits of acceptable standards of pharmacy practice and state and federal laws. This position requires interactions at all levels of staff and management. External interactions include network physicians, and health plan members, etc. Qualifications - 5 years or more as a practicing pharmacist - 3 years of experience in the managed care pharmacy field - 2 years of direct prior authorization experience - 2 years of managed care/health plan and/or pharmacy benefits experience - Doctor of Pharmacy (Pharm.D) degree - Active, current and unrestricted State of Arizona pharmacist license - Medicare Part D experience highly desirable (preferred) - Pharm. D with residency or fellowship preferred (preferred) - Geriatric certification (preferred) Requirements - Proficient in critical literature evaluation skills, including evidence-based medicine principles - Excellent problem-solving skills - Strong written and verbal communications - Intermediate PC proficiency - Intermediate skill in use of office equipment, including copiers, fax machines, scanner and telephones - Intermediate skill in word processing, spreadsheet and database software - Intermediate skill using departmental BCBSAZ and BCBSA software - Must have effective human relations and verbal/written communication skills - Must have an understanding of the interrelationships of health plan pharmacy components, members, and providers - Proficiency with PC based productivity tools required - Needs analytical ability to support decision making - Flexible skills in an operationally changing environment - Strong customer service skills - Interpersonal skills that allow for harmonious relationships with providers, members and coworkers - Recognize strategic opportunities and use data to make timely and sound decisions - Flexibility and willingness to adjust to shifting demands/priorities Benefits - Remote work opportunity requires residency within the State of Arizona - Hybrid workforce strategy offers flexibility with how and where employees work - Onsite requirements may change based on business need and job responsibilities Company Description Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.
Certified Pharmacy Technician
AnewHealthAnewHealth is a national medication management and pharmacy care provider committed to delivering transformative pharmacy solutions that elevate care and enhanc
Role Description Pharmacy Technicians in our Patient Care Center of Excellence may hold multiple duties to ensure ExactCare’s patients receive quality care out of their pharmacy services. They will work in a closed-door pharmacy environment, spending their time speaking with patients, doctors, and facilities on the phone in addition to the outlined job duties and responsibilities. - Providing an exceptional customer service experience each day in a phone-based environment. - Enter a high volume of data; processing prescription information with speed and accuracy. - Utilizing sound drug knowledge to effectively receive prescription authorizations, clarifications, or transfers. - Perform claim adjudication and auditing duties such as prior authorizations, billing, and eligibility checks, requiring outbound calls to patients. - Working through current case queues to problem solve for patient care issues. - Serving as a liaison between the clinical pharmacists and other medical professionals on the patient’s behalf. - Partner with technicians and pharmacists to ensure that new patients are successfully on-boarded to ExactCare. - Maintaining patient records with strong attention to detail and confidentiality. - Accurate retrieval of all prescription information and verifying through doctor calls. - Placing welcome calls to newly on-boarded patients and establishing a trusted point of contact. - Placing outbound calls to patients to create, maintain, or update their medication profiles. - Serve as backup support for times of higher patient call volume. - Effectively assist with patient questions over the phone. - Performing in a high volume, fast-paced environment to support ExactCare’s nationwide patient base. - Embody AnewHealth’s Core Values in all communications and interactions. - Other duties as assigned. Qualifications - High school diploma/GED - Certified with the Pharmacy Technician Certification Board (PTCB) or the National Health Association (NHA) and maintain a current certificate - Must maintain a pharmacy technician registration with State Board of Pharmacy - Must be 18+ years of age - Prior experience in a pharmacy setting - Ability to perform in an office-based (or remote) setting that requires sitting at a desk 90% of the time - Comfortable working in a phone-based environment. - Ability to work independently. - Self-motivated and goal-oriented. - Ability to utilize computer equipment, technology and work within multiple software programs to receive medication authorizations, clarifications, and/or transfers. - Exceptional customer service skills; servicing doctor’s office, pharmacist, and patient needs over the phone. - Thorough drug knowledge. - Pharmacy billing knowledge. - Knowledge of appropriate processes in taking prescriptions, clarifications, and transfers including clear written and verbal communication. - Strong prioritization and organizational skills. - Maintain a high degree of confidentiality. - Passion to help people and enrich their lives. - Ability to think critically and document pertinent details in a world-class manner that is compliant with state and federal regulations. Schedule This is a full-time position with an expectation to work an average of 40 hours per week and be available outside of normal business hours to meet customer expectations on an ad-hoc basis. Schedules are set to accommodate the requirements of the position and the needs of the organization and may be adjusted as needed. This is a remote position. Benefits - Medical/dental/vision coverage effective 1st of the month following date of hire - Flexible spending - Company-paid life insurance and short-term disability - Voluntary benefits - 401(k) - Paid Time Off and paid holidays
Member Flex Guide
Devoted HealthDevoted Health was founded in 2017 to provide seniors with healthcare plans and personalized health guides using world-class technology. On a mission to make he
Role Description As a Member Services Guide (MSG) OR a Member Outreach Specialist (MOS) at Devoted Health, you will be a primary point of connection for our members, meeting them where they are, understanding what they need, and helping them navigate the complexities of healthcare with empathy, accuracy, and care. Guides at Devoted work across a range of member-facing functions. Depending on your placement, your home base may focus on: - Inbound service — responding to member questions, resolving benefit issues, and supporting care navigation in real time. - Proactive outreach — connecting members with clinical programs, scheduling care, and helping them get ahead of their health needs. Every Guide is expected to flex across both inbound and outbound work as business needs evolve. This flexibility is core to how this team operates and how we serve members well. In every interaction — whether voice, video, SMS, chat, or digital messaging — you’ll bring our mission to life: treating every member like family. You’ll do this by: - Actively listening and anticipating needs. - Breaking down complex information into clear and actionable guidance. - Working alongside our AI Guide Assistant, a real-time tool designed to help you access information instantly. Qualifications - 1+ years of experience in a high-volume customer-facing role or fast-paced healthcare environment. - Genuine passion for improving the healthcare experience. - Ability to work a flexible schedule based on business needs. - Exceptional interpersonal and communication skills and high emotional intelligence. - Ability to de-escalate intense or emotionally charged interactions with empathy and composure. - Comfort working alongside AI-powered tools and digital platforms. - Strong multitasking ability. Requirements - Experience in a contact center or call center environment. - Experience in healthcare, health insurance, or Medicare Advantage. - Experience working in highly regulated environments, ideally with HIPAA guidelines. - Proven ability to navigate multiple software platforms simultaneously. - Experience using effective stress management techniques. - A track record of applying feedback quickly and demonstrating visible growth. Benefits - Employer sponsored health, dental and vision plan with low or no premium. - Generous paid time off. - $100 monthly mobile or internet stipend. - Stock options for all employees. - Bonus eligibility for all roles excluding Director and above; Commission eligibility for Sales roles. - Parental leave program. - 401K program. - And more... Company Description At Devoted Health, we’re on a mission to dramatically improve the health and well-being of older Americans by caring for every person like family. We are committed to a diverse and vibrant workforce. Founded in 2017, we've grown fast and now serve members across the United States. Join us on this mission!



