Director, Pharmacy Network
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Job Description
Director leading Medicaid Fraud, Waste & Abuse operations within Gainwell Technologies. Overseeing pharmacy network management and ensuring compliance with regulations and program integrity.
Responsibilities:
- Lead the vision, strategy, and execution of Medicaid FWA and pharmacy network management programs
- Drive initiatives that strengthen program integrity, optimize network performance, and meet state Medicaid expectations
- Monitor industry trends, regulatory changes, and emerging fraud schemes
- Manage and develop managers, analysts, investigators, and network operations staff
- Build a collaborative, high-performance culture with clear goals and professional growth opportunities
- Ensure teams operate with integrity, accountability, and operational excellence
- Oversee FWA detection, investigation, prevention, and reporting activities
- Partner with state agencies, law enforcement, and internal compliance teams on FWA matters
Requirements:
- Advanced degree or significant related experience
- 10+ years of pharmacy-related experience
- Extensive experience in Medicaid program integrity, FWA operations, pharmacy network management
- Experience interacting with clients in the healthcare industry
- Track record of cross-functional leadership of teams and projects
- Excellent communication skills
- Innovative forward thinker with excellent leadership skills
- Proven success leading teams and developing leaders
- Strong understanding of Medicaid regulations, pharmacy operations, and provider network dynamics
- Ability to build relationships with regulators, providers, and internal stakeholders
- Strategic mindset with the ability to execute in a fast-paced, highly regulated environment.
Benefits:
- generous, flexible vacation policy
- 401(k) employer match
- comprehensive health benefits
- educational assistance
- leadership and technical development academies
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