John D. Nimsky
Senior Consultant

Mr. Nimsky is a healthcare executive with more than twenty-five years of senior leadership experience in health plan and provider operations, partnership formation, business development, strategic visioning, managed care and governmental programs.

Areas of Expertise:

  • Health plan operations including network management, provider relations, utilization management and customer service operations
  • Contract negotiations with emphasis on unit cost analysis, reimbursement methodology configuration and fee setting
  • Expertise in reimbursement strategies including capitation, DRG per diems, case rates, gain sharing, and other incentive based reimbursement models for provider stakeholders
  • Strategic planning and project management relating to medical campus development, health plan formation and program service line development
  • Business development & analysis for hospital, physician and health plan operations focusing on product development, proforma analysis and revenue recovery strategies
  • Marketing/public relations resulting in several award winning electronic and written media advertisements
  • Strategic partnership-venture development including provider owned health plan start up, hospital acquisition, bio-med joint venture development and physician practice acquisition and management.

Mr. Nimsky has held numerous senior executive positions with statewide and national provider and health plan organizations in the role of administrator, regional vice president and corporate director for organizations including Columbia/HCA, Blue Cross Blue Shield of Arizona, Coventry Health Plans, Scottsdale Healthcare, and PMH Health Resources. He is currently president of his own consultant company, a senior consultant with a national consulting firm specializing in joint venture formation and business turnaround, as well as providing consultative services to the ATTAC Consulting Group. In addition to his health experience, Mr. Nimsky has extensive government experience as a political consultant, city and state government executive and serves on numerous community and professional organization boards.

CMS Publishes Final 2009 MA Capitation Rates and Part D Payment Policies; CMS Will Conduct Plan Level Audits and Not Make Coding Intensity Adjustments for 2009, 04.10.08
Other SNP Sponsors Could Follow In QMed's Wake, Consultant Says; Medicare Advantage News, 11.15.07
The Medicare Outlook: Keys to Success in the New Senior Market, Munich Re America HealthCare Newsletter, 11.01.07
 
Protecting Beneficiaries: Improving & Monitoring Medicare Marketing Practices - AHIP, 05.07
Hard Sell Cited as Insurers Push Plans to Elderly, New York Times, 05.07.07
Advantage Plan's Risk- Wall Street Journal, 04.22.07
Power Shift in Congress Revives Health Debate - New York Times, 01.02.07
 

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