J Nisha Der Weer, MBA
About J Nisha Der Weer, MBA
J Nisha Der Weer, MBA, serves as the Pharmacy Government Programs Manager at EmblemHealth, where she oversees claims processing and compliance with regulatory guidance. With a background in pharmacy and health care administration, she has held various roles within EmblemHealth since 2009 and has expertise in Medicare initiatives.
Current Role as Pharmacy Government Programs Manager
J Nisha Der Weer serves as the Pharmacy Government Programs Manager at EmblemHealth, a position she has held since 2019. In this role, she oversees the execution of claims processing and issue management in collaboration with Express Scripts. Her responsibilities include ensuring compliance with Centers for Medicare & Medicaid Services (CMS) and state regulatory guidance. She also acts as a subject matter expert for the implementation of Government Program initiatives, which involves defining monitoring plans and training team members.
Previous Experience at EmblemHealth
Prior to her current role, J Nisha Der Weer held several positions at EmblemHealth. She worked as a Medicare Pharmacy Specialist from 2010 to 2015, a Senior Medicare Pharmacy Specialist from 2015 to 2018, and a Lead Government Programs Coordinator from 2018 to 2019. Her early career at EmblemHealth also included a role as a Medicare Pharmacy Assistant from 2009 to 2010 and as a Pharmacy Clerk from 2008 to 2009. Throughout these roles, she developed oversight dashboards and reporting capabilities to ensure compliant processes.
Educational Background
J Nisha Der Weer earned a Bachelor's degree in Biology from Syracuse University, where she studied from 2003 to 2008. She later pursued a Master of Business Administration (MBA) in Health/Health Care Administration/Management at Ohio University, completing her studies from 2016 to 2018. Her educational background provides a strong foundation for her work in pharmacy management and government programs.
Contributions to Medicare Programs
In her current role, J Nisha Der Weer contributes to the Annual Enrollment Period (AEP) process by providing guidance on Medicare Part D requirements. She partners with Pharmacy Services to develop comprehensive testing strategies for new Medicare requirements, ensuring that EmblemHealth remains compliant with evolving regulations and effectively serves its members.
Experience in Pharmacy Operations
J Nisha Der Weer's experience in pharmacy operations includes her role as a Pharmacy Clerk at Syracuse University from 2006 to 2008. This early experience in the pharmacy sector laid the groundwork for her subsequent positions in government programs and compliance management within the healthcare industry.