Domain Testing / Program Manager - PBM/Medicaid

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. Key Responsibilities 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. Required Domain Expertise Strong experience in PBM (Pharmacy Benefit Management) modules including: 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 Preferred Qualifications 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 DevOps, or similar. Strong communication and leadership skills. Certifications in PMP, Scrum, ISTQB, or Healthcare domain are a plus. Education 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.