Gainwell Technologies

Software Engineer

• Demonstrate leadership and passion for client outcomes
• Leads new development and modernization of products, technology, and cultural shifts
• Collaborates with Product Management to shape product roadmap
• Works with engineering leaders to drive cohesion, standards, and best practices
• Partners with vendors to obtain best prices, products, upgrades, and enhancements
• Manages delivery expectations and balances priorities across multiple clients
• Supports product implementations and production for clients
• Coaches, develops, and leads diverse teams
• Uses Agile methodology to plan client commitments and drive development and support of solutions

Director, Engineering

Manager

• Oversight of prior authorization, pharmacist appeals, and peer-to-peer DLP creation, modification, training, and implementation
• Collaboration with internal leaders/teams including, but not limited to: Claims, Grievance and Appeals, Clinical, Quality Assurance, Network, and Training
• Evaluate drug and drug class reviews following evidence-based research and processes widely accepted by the medical community
• Maintain up-to-date knowledge of medications, drugs, and prescribing practices; advise Gainwell leaders based on your knowledge and expertise
• Help write consultation and intervention scripts to support continuous improvement and quality improvement processes
• Assist Gainwell clinical leadership in reviewing clinical criteria and Preferred Drug List (PDL) recommendations used to make coverage and PDL placement decisions

Senior Manager, Prior Authorizations – Pharmacist

Claims Specialist

• Review and organize medical documentation, including procedure and diagnosis codes, to support case management activities
• Utilize Excel (filtering, sorting, and basic data analysis) to manage and track case information efficiently
• Maintain accurate and timely documentation across systems and workflows
• Support case processing by identifying missing or incomplete information and ensuring follow-up actions are completed
• Collaborate with internal teams to ensure alignment on case status and processing requirements
• Apply attention to detail to ensure data accuracy and compliance with established guidelines
• Manage workload effectively to meet productivity and quality expectations

Medical Claims Analyst

Security Engineer

• Define and maintain a cybersecurity metrics framework (KPIs, KRIs, OKRs) that supports executive decision-making
• Develop and maintain a data dictionary and standardized definitions for all key metrics
• Design and maintain logical and physical data models for cybersecurity reporting
• Leverage ServiceNow as a core source of truth for workflow and status metrics
• Develop and standardize ServiceNow-based reports, dashboards, and potentially Performance Analytics indicators
• Apply best practices in visualization and information design to keep dashboards clear, actionable, and aligned with stakeholder needs
• Implement governance for dashboard lifecycle
• Partner with the Senior Principal, Vulnerability Management to ensure Tenable- and VM-related metrics align with risk models and program goals
• Support Security Leadership in using metrics for planning, prioritization, and communication

Advisor, Program Effectiveness – Cybersecurity Metrics & Reporting

Backend Engineer

• Codes, tests, debugs, implements, and documents programs
• Assists in the modification of company products and/or customer/internal systems to meet client needs
• Gathers information from the system, analyzes program and time requirements, and prepares documentation
• Researches and analyzes existing systems and program requirements
• Designs programs for projects or enhancements to existing programs
• Writes specifications for programs of low to moderate complexity
• Assists in resolving production support problems
• Develops and suggests alternative approaches to resolving problems
• Creates appropriate documentation in work assignments

Senior Web Developer – ASP.NET/C#

• Design, develop, and implement Microsoft Dynamics 365 Customer Engagement (CRM) solutions in alignment with Gainwell application development standards.
• Collaborate with business stakeholders and functional analysts to gather, analyze, and document requirements.
• Customize and configure Dynamics 365 entities, forms, views, business rules, workflows, and security roles to meet business needs.
• Develop and maintain custom plugins, workflows, and integrations using C#.NET and JavaScript.
• Build extensions and custom components using Power Apps and Power Automate (Flows).
• Develop and support Power BI reports and dashboards leveraging Dynamics 365 data.
• Perform unit testing, system validation, and support defect resolution activities.
• Provide ongoing application support and maintenance for the Dynamics 365 platform.
• Create and maintain technical documentation, including design specifications, configurations, and deployment guides.
• Ensure CRM solutions comply with Gainwell security, quality, and operational standards.

CRM Developer – Dynamics 365, CE

Business Analyst

• Ensure that items are prepared for client meetings.
• Ensure Operating Procedure Manuals are updated as required
• Work with the client on change requests, publications and claim adjustments/reprocessing
• Research, identify, and specify solutions to problems.
• Document updates for all reference updates/changes.
• Work with the systems team on any assigned system changes, meeting required timelines
• Assist with quarterly and annual CPT, HCPCS and diagnosis code updates in the system, ensuring rules are correct and working on edit and audit configuration.

Senior Business Analyst – Healthcare Claims, MMIS

Product Manager

• Define and execute the product vision, strategy, and roadmap for Healthcare Effectiveness Data and Information Set (HEDIS) and other Quality Measures to support Medicaid and enterprise healthcare data needs.
• Align product initiatives with business objectives, regulatory requirements, and customer needs to drive data-driven decision-making.
• Collaborate with stakeholders to translate business and regulatory requirements into technical specifications for the Quality Measures product.
• Work closely with IT, analytics, and compliance teams to establish priorities, manage timelines, and ensure seamless execution of data initiatives.
• Drive the delivery of the Quality Measures results for each customer.
• Drive the product roadmap, ensuring scalability, security, and performance of Quality Measures while maintaining adherence to HIPAA and Medicaid data standards.

Product Owner – Quality Measures

CRM Developer – Dynamics 365

CRM Dynamic Developer

• Own end-to-end delivery of data platform products built on Databricks and AWS, balancing KTLO and new feature(s) development.
• Lead and manage a cross-functional team of data engineers and product partners, while remaining technically hands-on when needed.
• Actively contribute to data engineering design and implementation, including pipelines, data models, transformations, and performance tuning.
• Translate business requirements into scalable data products and well-prioritized execution plans.
• Drive platform reliability, performance, scalability, and cost optimization across AWS and Databricks.
• Establish and enforce best practices for data engineering, Spark development, CI/CD, monitoring, and data quality.
• Oversee production operations, incident management, and continuous improvement for data pipelines and analytics workloads.
• Partner with architecture, security, and compliance teams to ensure solutions meet enterprise and regulatory standards.
• Communicate clearly with stakeholders on progress, risks, delivery metrics, and business impact.
• Mentor and grow engineering talent, fostering strong technical ownership and a product-centric mindset.

Senior Manager, IT

Director

• Leads key client implementation initiatives through global delivery networks
• Ensures quality and consistency of project delivery to clients
• Provides leadership across delivery teams and owns executive-level client communication
• Oversees engagement-level delivery budgets while ensuring compliance with contracts
• Partners with legal and financial teams to assess compliance and best practices

Director, Engagement Lead

Systems Engineer

• Lead the design and evolution of the ServiceNow platform architecture, ensuring alignment with enterprise standards and business needs
• Define and enforce platform governance, including release management and security protocols
• Provide architectural solutions for integrating third-party tools into the corporate ServiceNow instance
• Design, document, and maintain the information architecture for the ServiceNow platform
• Lead the modeling and structuring of data within ServiceNow applications
• Partner with platform engineers, product owners, developers, and process owners to define data flows, integrations, and taxonomies
• Guide the optimization of CMDB health, data integrity, and relationship modeling

Advisor, Information Systems Architect – Service Now

Customer Success Manager

• Build and lead a core team of consulting and client success professionals.
• Work with service line leadership to develop and execute on go to market campaigns for the Data and Analytics (D+A) and Population Health Management (PHM) service lines.
• Scope and manage consultative engagements and workstreams with clients - typically around well-defined service line topic areas (e.g., data strategy, high-level PHM strategy).
• Coordinate with Delivery teams to provide consultative client support and project management for implementation programs.
• Project manage partnerships and vendors supporting consultative engagements in growth service lines - including coordination with consulting partners.
• Lead solution teams in the design and early-stage development of new capabilities.
• Help build and manage the growing D+A function, including associated administrative and operational activities (e.g., staffing, P+L management, pipeline management).
• Support client development.

Vice President, Consulting & Client Success

Auditor

• Perform DRG validation (clinical/coding) reviews of medical records
• Audit medical records for accuracy of diagnosis and procedure codes
• Maintain knowledge of coding guidelines and CEUs for RN license and coding certification
• Train new Coders or Clinical DRG Auditors