Domain Testing​/Program Manager – PBM​/Medicaid

Job Title:
Domain Testing / Program Manager PBM/Medicaid

Location:
Plano, TX

Experience Required
10+ Years

We are seeking an experienced Domain Testing / Program Manager with strong expertise in Pharmacy Benefit Management (PBM) and Medicaid systems. The ideal candidate will lead end-to-end testing programs, quality assurance initiatives, release management activities, and stakeholder coordination across complex healthcare transformation projects.

• Lead domain testing activities for PBM/Medicaid applications and enterprise systems.
• Manage test planning, scope validation, resource coordination, and execution oversight.
• Develop and maintain test strategies, test plans, estimates, schedules, and entry/exit criteria.
• Ensure quality governance through defect triage, risk assessment, issue resolution, and reporting.
• Coordinate release readiness activities and support deployment planning.
• Collaborate with business stakeholders, product owners, development teams, and vendors to ensure successful delivery.
• Review business requirements, maintain Requirement Traceability Matrix (RTM), and ensure complete test coverage.
• Guide test design, test execution, data readiness, evidence collection, and reporting activities.
• Lead defect management processes including triage, root cause analysis (RCA), retesting, aging reviews, and defect closure.
• Drive continuous improvement initiatives in testing processes and quality assurance practices.
• Support implementation and adoption of AI-driven testing solutions and automation strategies.

• Member Eligibility
• Benefit Plan Configuration
• Formulary Management
• Pharmacy POS Claims Processing
• Claims Adjudication
• Prior Authorization
• Utilization Management
• Pricing and Reimbursement
• Accumulators
• Pharmacy Networks
• Payment & Settlement
• Reporting and Analytics

• PBM/Medicaid domain expertise
• Test Management and QA Leadership
• Program/Project Management
• Defect Management & Root Cause Analysis
• Release Management
• Stakeholder Management
• Requirement Analysis and RTM Management
• Test Planning and Estimation
• Risk and Issue Management
• AI-Driven Testing Tools and Methodologies

• Experience working with Healthcare, Medicaid, or Managed Care organizations.
• Knowledge of Agile/Scrum and Waterfall methodologies.
• Experience with test management tools such as JIRA, ALM, Azure Dev Ops, or similar.
• Strong communication and leadership skills.
• Certifications in PMP, Scrum, ISTQB, or Healthcare domain are a plus.

Bachelor's degree in Computer Science, Information Technology, Healthcare Informatics, or related field.

This role requires a blend of healthcare domain expertise, testing leadership, and program management capabilities to successfully deliver high-quality PBM/Medicaid solutions.