James Parmiter Jr Rph Email & Phone Number

Pennsylvania, United States

Work From Home

• Managed post-sign-off commercial custom formulary coding projects.• Translated complex client requirements into executable coding logic for RxClaim and RxBuilder platforms.• Conducted in-depth second-level formulary and utilization management (UM) claim research.• Provided clinical coding support for new client implementations.• Supported new client onboarding for custom formulary and UM program development.• Extracted, analyzed, and interpreted clinical coding data within adjudication and formulary management systems.• Resolved complex formulary coding issues and conflicts through rigorous analysis.• Offered expert consultative guidance on formulary changes within RxClaim and RxBuilder.• Contributed to GPI reclassification and global coding change initiatives for drug utilization management.

Greater Philadelphia Area

• Successfully implemented 4 new health plans with Medispan as the core of the platform, driving projects from contract to stabilization.• Developed comprehensive clinical plan structures by collaborating with cross-functional teams.• Partnered with clients to align plan designs with operational requirements.• Managed formulary maintenance and DUR (Prior Authorization, Quantity Limits) with claims processors.• Leveraged proficiency in GCN and GPI hierarchies for data accuracy.• Ensured claim processing accuracy through rigorous testing and validation of coding changes.• Led implementation tasks and coordinated project timelines for new business lines.• Utilized advanced Excel and Access skills to analyze and manage large datasets.

Greater Philadelphia Area

• Made critical decisions on complex cases adhering to strict guidelines and criteria.• Leveraged clinical expertise to resolve intricate case scenarios.• Rapidly acquired in-depth product knowledge to contribute effectively during peak workload periods.• Collaborated closely with team members to implement case decisions via virtual and phone-based communication.

Moorestown, Nj

• Provided comprehensive long-term care for nursing home residents from admission through hospice.• On-boarded new facilities by conducting thorough history reviews and implementing necessary service adaptations.• Performed in-depth clinical assessments for new patients and offered recommendations for optimal care.• Collaborated with prescribers and nurses to achieve desired patient outcomes.• Ensured medication safety by verifying accuracy and completeness of all new and refill orders.

Oxford Valley, Pa

• Conducted facility visits to educate prescribers and nursing staff on medication therapy options, emphasizing efficacy and cost-effectiveness.• Managed medication transitions by verifying patient medication profiles during level of care changes.• Established strong clinical relationships with physicians and nurses to optimize patient medication therapy.• Developed in-depth understanding of nursing home patient needs and facility care processes.

Greater Philadelphia Area

• Conducted Medication Therapy Management (MTM) reviews for underserved populations to identify medication-related gaps and opportunities.• Onboarded new state Medicaid plans by providing exceptional customer service and establishing strong partnerships.• Reviewed and assessed coverage determinations for pharmacy, physician, specialty, and home infusion pre-authorization and medical necessity requests.• Adjudicated Medicare coverage determinations in alignment with CMS guidelines.

Willingboro, Nj

• Disease and Adherence Counseling (Cardiovascular, Immunology, Oncology)• DUR/MTM Experience• Trained and mentored pharmacists and technicians in new processes and onboarding

Willingboro, Nj

• Specialized clinical expertise in Immunology, Oncology, and Cardiology.• Collaborated with Pfizer on the Center for Pharmaco-therapeutic Research (CPTR) program to enhance patient statin adherence.

• Successfully adapted to new dispensing system while maintaining uninterrupted patient care and medication adherence.

• Prioritized patient health and well-being through medication dispensing, counseling, and leveraging all my years of pharmacy expertise.

Pharmacy, Pharmacy

Activities and Societies: Phi Delta Chi Professional Pharmacy Fraternity #662

Certification, Training Course For Pennsylvania Medical Marijuana Program Practitioners & Medical Professionals