Director, FWA, Pharmacy Network- Remote

It takes great medical minds to create powerful solutions that solve some of healthcare's most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you've honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you'll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You'll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development.SummaryWe are seeking a seasoned, strategic, and mission-driven Director to lead our Medicaid Fraud, Waste & Abuse (FWA) and Pharmacy Network Management functions. In this role, you will oversee program integrity operations, shape pharmacy network strategy, and lead high-performing teams dedicated to protecting Medicaid dollars while ensuring strong pharmacy access and provider accountability.The ideal candidate brings deep Medicaid expertise, exceptional people leadership skills, and a passion for building compliant, data-driven, and operationally excellent programs. This leader directs multidisciplinary operations teams, partners closely with state Medicaid agencies, ensures adherence to federal and state regulations, and drives initiatives that strengthen program integrity and enhance member access, provider performance, and overall network value. The Director is responsible for setting strategy, managing people and processes, and delivering measurable results across both domains.Your role in our missionLead the vision, strategy, and execution of Medicaid FWA and pharmacy network management programsDrive initiatives that strengthen program integrity, optimize network performance, and meet state Medicaid expectationsMonitor industry trends, regulatory changes, and emerging fraud schemes to proactively evolve program strategyManage and develop managers, analysts, investigators, and network operations staffBuild a collaborative, high-performance culture with clear goals, coaching, and professional growth opportunitiesEnsure teams operate with integrity, accountability, and operational excellenceOversee FWA detection, investigation, prevention, and reporting activitiesGuide the use of analytics, audits, and surveillance tools to identify high-risk providers and suspicious billing patternsEnsure timely case management, documentation, referrals, and corrective action plansPartner with state agencies, law enforcement, and internal compliance teams on FWA mattersDirect the strategy, performance, and compliance of the Medicaid pharmacy networkOversee contracting, credentialing, reimbursement methodologies, and network adequacyMonitor pharmacy performance metrics and lead initiatives to improve access, quality, and cost-effectivenessAddress high-risk pharmacy behavior and support provider education and engagementServe as a primary liaison with state Medicaid agencies and regulatory bodiesEnsure accurate and timely submission of required reports, audits, and corrective action plansTranslate regulatory requirements into operational processes and team workflowsEstablish KPIs, dashboards, and reporting to track FWA outcomes and network performanceLead process improvements to enhance efficiency, accuracy, and complianceOversee vendor relationships supporting FWA analytics, SIU functions, and credentialingManage budgets, resource planning, and ROI analysis for program initiativesWhat we're looking forAdvanced degree or significant related experience10+ years of pharmacy-related experienceExtensive experience in Medicaid program integrity, FWA operations, pharmacy network management, or related healthcare regulatory fieldsExperience interacting with clients in the healthcare industryTrack record of cross-functional leadership of teams and projects spanning people, process, and technologyExcellent communication skills, with the ability to communicate externally and with senior executivesInnovative forward thinker with excellent leadership skillsProven success leading teams and developing leadersStrong understanding of Medicaid regulations, pharmacy operations, and provider network dynamicsAbility to build relationships with regulators, providers, and internal stakeholdersStrategic mindset with the ability to execute in a fast-paced, highly regulated environmentWhat you should expect in this roleThis position is 100% remote within the USApproximately 20% of travel to support key client meetingsThis posting is intended for pipelining purposes and will remain open to accept applications on an ongoing basis.The pay range for this position is $127,400.00 - $180,000.00 per year, however, the base pay offered may vary depending on geographic region, internal equity, job-related knowledge, skills, and experience among other factors. Put your passion to work at Gainwell. You'll have the opportunity to grow your career in a company that values work flexibility, learning, and career development. All salaried, full-time candidates are eligible for our generous, flexible vacation policy, a 401(k) employer match, comprehensive health benefits , and educational assistance. We also have a variety of leadership and technical development academies to help build your skills and capabilities.We believe nothing is impossible when you bring together people who care deeply about making healthcare work better for everyone. Build your career with Gainwell, an industry leader. You'll be joining a company where collaboration, innovation, and inclusion fuel our growth. Learn more about Gainwell at our company website and visit our Careers site for all available job role openings.Gainwell Technologies is an Equal Opportunity Employer, where all qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical condition), age, sexual orientation, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Gainwell Technologies defines "wages" and "wage rates" to include "all forms of pay, including, but not limited to, salary, overtime pay, bonuses, stock, stock options, profit sharing and bonus plans, life insurance, vacation and holiday pay, cleaning or gasoline allowances, hotel accommodations, reimbursement for travel expenses, and benefits.