Scaling or Optimizing Your Medicaid Operations in Nevada? We’ve Got You Covered

The recent announcement of the intent to award Medicaid contracts in Nevada presents both opportunities and challenges for health plans. Whether you are an incumbent plan seeking to optimize performance or a new entrant preparing for go-live, ProspHire specializes in providing strategic support to drive operational success.

Opportunities in Focus

• Operational Readiness
  • Develop and execute a comprehensive implementation plan to meet state requirements.Establish effective workflows, IT system integration, and operational policies.
  • Conduct readiness assessments to mitigate risks prior to go-live.
• Provider Network Expansion & Management
  • Assess and expand provider networks to meet state adequacy standards.Implement contracting strategies to enhance access to care and quality measure performance.
  • Improve provider relations and streamline credentialing processes.
• Regulatory Compliance
  • Ensure alignment with Nevada Medicaid regulations and reporting requirements. Conduct compliance audits and gap analyses.
  • Develop policies and procedures to maintain ongoing compliance.
• Quality Programs, Performance & Addressing Health Disparities
  • Optimize HEDIS and Medicaid quality measures to improve performance.Implement care management programs to enhance member health outcomes.Align quality initiatives with state and federal benchmarks.Implement social determinants of health (SDOH) strategies.Develop community engagement initiatives to improve equity in care.
  • Leverage data analytics to identify and address disparities
• Member Experience
  • Improve CAHPS and member satisfaction scores through targeted interventions.
  • Develop data-driven member engagement strategies.
• Administrative Cost Savings
  • Identify cost-containment opportunities to maximize efficiency.Streamline operations to reduce administrative burden through systems integration, process automation, and strategic workflow optimization.
  • Leverage technology to enhance claims processing, contracting and other productive repetitive activities.

ProspHire Can Help

By partnering with us, health plans can confidently navigate the complexities of Medicaid implementation and achieve operational excellence in Nevada’s evolving landscape. Contact us today to learn more about how we can support your success.