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Formulary Analyst
MotivHealthFormulary Analyst at MotivHealth supporting the development and administration of pharmacy formularies. Ensuring formulary accuracy and compliance while collaborating with internal teams and plan sponsors.
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in formulary management and pharmacy benefits, with a strong focus on compliance with regulatory requirements such as ACA and ERISA. Proficient in analyzing drug utilization trends and collaborating with cross-functional teams to optimize formulary structures.
Highest-signal resume keywords
Formulary ManagementPharmacy BenefitsDrug Utilization AnalysisRegulatory CompliancePharmacy Claims Systems
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Formulary ManagementDrug Utilization AnalysisPricing Data InterpretationUtilization Management CriteriaDrug ClassificationsTiering StructuresPrior Authorization ProcessingStep Therapy CriteriaQuantity Limit CriteriaDocumentation Management
Soft Skills
Analytical SkillsCommunication SkillsDetail-OrientedOrganizational Skills
Tools & Technologies
Formulary Management ToolsPharmacy Claims Systems
Industry Keywords
Pharmacy Benefit ManagersFDA ApprovalsGeneric ReleasesBiosimilar ReleasesACA ComplianceERISA Compliance
About the role
Key responsibilities & impact- Build, maintain, and update pharmacy formularies in alignment with plan design and client specifications
- Analyze drug utilization trends, pricing, and rebate data to support formulary decision-making
- Collaborate with PBMs (Pharmacy Benefit Managers) to ensure accurate formulary loading and claims adjudication
- Review and process prior authorization, step therapy, and quantity limit criteria within formulary structures
- Monitor drug pipeline updates, new FDA approvals, and generic/biosimilar releases to recommend formulary changes
- Partner with underwriting, account management, and client services teams to communicate formulary structures and plan-specific pharmacy benefits
- Ensure formulary compliance with ACA, ERISA, and other applicable regulatory requirements
- Assist in resolving member and provider inquiries related to formulary coverage and exceptions
- Maintain accurate documentation of formulary changes, rationale, and version history
Requirements
What you’ll need- 2 + years of experience in formulary management, pharmacy benefits, or PBM operations
- Familiarity with pharmacy claims systems and formulary management tools
- Strong understanding of drug classifications, tiering structures, and utilization management criteria
- Excellent analytical skills with the ability to interpret pharmacy utilization and pricing data
- Strong communication skills, with the ability to explain formulary decisions to both technical and non-technical stakeholders
- Detail-oriented with strong organizational and documentation skills
Benefits
Comp & perks- MotivHealth is a dynamic and mission-driven health insurance company dedicated to disrupting the status quo by making healthcare simpler and more affordable for our members