PBM Call Center Manager - Remote US

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.

Summary

Gainwell Technologies is seeking an experienced PBM Call Center Manager to lead day-to-day operations within a Pharmacy Benefit Management (PBM) call center environment. In this role, you will oversee service delivery while driving operational performance, quality, compliance, and an exceptional customer experience.
The ideal candidate brings strong healthcare operations and contact center leadership experience, with knowledge of Medicaid and/or PBM operations. You will lead teams, monitor performance and service levels, manage escalations, and partner across the organization to continuously improve processes and outcomes.

Your role in our mission

• Lead day-to-day PBM call center operations, ensuring service levels, productivity, quality, and customer experience goals are achieved.
• Lead, coach, and develop supervisors and customer service teams through effective performance management, ongoing feedback, and employee development.
• Monitor and analyze SLAs, KPIs, quality metrics, customer satisfaction, and operational trends to identify opportunities for improvement.
• Ensure compliance with Medicaid, HIPAA, PBM, contractual, and applicable regulatory requirements.
• Oversee workforce planning, staffing, scheduling, training, and operational readiness to effectively support business and client needs.
• Partner with clients, pharmacies, providers, state stakeholders, and internal teams to resolve escalations, address service issues, and implement process improvements.

What we're looking for

• Three (3) or more years of experience in healthcare, Medicaid, PBM, pharmacy, or related healthcare operations.
• Demonstrated leadership experience managing teams within a high-volume call center or contact center environment; five (5) or more years of call center leadership experience is preferred.
• Strong knowledge of call center operations, including SLAs, KPIs, quality management, workforce planning, performance management, and customer experience.
• Knowledge of NCPDP standards and healthcare regulatory and compliance requirements.
• Strong analytical, communication, problem-solving, and leadership skills with the ability to analyze data and translate findings into operational improvements.
• Medicaid/PBM experience strongly preferred; experience with pharmacy claims, prior authorization, Lean Six Sigma, project management, and/or Pharmacy Technician certification is a plus.

What you should expect in this role

• Work remotely from home while leading and supporting a geographically dispersed healthcare operations team.
• Work in a fast-paced, performance-driven environment focused on quality, compliance, operational excellence, and customer service.
• Regularly collaborate with clients, internal business partners, pharmacies, providers, and other healthcare stakeholders.
• Use operational data and performance metrics to identify trends, address service gaps, and drive continuous improvement.
• Comprehensive benefits for eligible employees, including medical, dental, and vision coverage, access to a 401(k) retirement savings plan, and additional employee wellness and financial benefits.
• Opportunities for professional development and career growth within Gainwell Technologies.

#LI-REMOTE

#LI-JT1

#LI-CM1

The pay range for this position is $87,300.00 - $124,700.00 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.