• Adjudicate insurance claims and resolve rejections in multi-state environment • Properly handle order exceptions such as refill-too-soon, invalid orders, etc. • Working with prescribers to clarify prescriptions and obtain prior authorizations • Manage routine notification of insurance issues and communicate with caregivers • Stay updated on current Medicare/Medicaid policies and common insurance practices • Work with others to resolve common coverage issues or concerns.

• Manages the 5-in-the-box cross-functional product leadership team, including strong partnership with Business General Manager (GM) • Accountable for the teams’ delivery and final output to stakeholders • Partners with business general manager and stakeholders to make decisions on investment priorities and develop business cases • Defines and socializes the product vision, strategy and roadmap in collaboration with the 5-in-the-box team; assesses and refines as needed • Translates customer and business needs into short-term and long-term product strategy by creating Epics/initiatives defined to meet targeted outcomes • Connects the roadmap to specific value drivers that contribute to business priorities, objectives and key results, and strategic programs • Sets the direction for discovery work, ensuring that the product team is focused on continuous exploration • Understands the hiring market to identify successful candidates with the unique blend of personality and skillset matches • Champions strong product management and agile mindsets and values by actively communicating team wins and opportunities • Defines product objectives and key results (OKRs), aligned with business objectives, to evaluate progress towards outcomes • Tracks product objectives and key results (OKRs), aligned with business objectives, to understand progress towards outcomes and metrics to understand product health, socializes progress, and consistently reinforces objectives and alignment with broader product portfolio outcomes

Provide quality pharmaceutical services by interpreting, dispensing, and monitoring medications. Participate in clinical initiatives, train new staff, and manage inventory and customer service to ensure optimal pharmacy performance.

• Serve as the primary clinical SME on pharmacy implementations • Lead clinical and drug reference domains on pharmacy design, development, and implementations (DDIs) • Be a primary point of contact with the state client pharmacy team during the DDI and hypercare phases • Ensure benefit plan drug coverages are configured accurately to state client specifications and requirements • Validate successful and accurate conversion of pharmacy data from other vendors and stakeholders • Ensure all point‑of‑sale (POS) claims processing edits, pricing, return messaging, and configuration meet the business requirements of the client • Work with engineering and pharmacy business analyst teams to configure automated PA rule sets and electronic prior authorization (EPA) question sets, including testing scenarios and validation with the client • Track and document progress of clinical domain activities against requirements and timelines, and provide status reports to senior leaders • Identify risks or issues, ensure they are documented and tracked, and work with appropriate stakeholders to resolve them • Maintain a clear understanding of the operational readiness, certification, and delivery status of all Gainwell pharmacy implementations • Provide subject matter expertise for pharmacy and drug rebate product development, sales pursuits, RFP responses, and DDIs • Encourage and strengthen cohesiveness and team unity across the pharmacy business and stakeholders on all Gainwell pharmacy implementations • Participate in corporate pharmacy team meetings