Healthcare Investigator

This is a fully remote position, open to applicants in Ohio.

📋 Description

• Conduct investigations into reported incidents involving Medicaid recipients and providers.

• Analyze clinical records, incident reports, billing documents, and other pertinent materials.

• Interview recipients, providers, witnesses, and other parties involved.

• Record investigative actions, findings, and conclusions in the incident reporting system.

• Identify violations of rules, contributing factors, and potential risks.

• Create clear and well-supported investigation summary reports.

• Provide education to Medicaid providers regarding applicable rules, responsibilities, and best practices for service delivery.

• Coordinate and refer cases to law enforcement, county children services, Adult Protective Services, county boards of developmental disabilities, and other oversight or regulatory agencies.

• Collect information and prepare referrals to the Ohio Department of Medicaid for suspected or serious provider misconduct.

• Uphold professionalism and confidentiality while working independently in a remote setting.

• Carry out other assigned duties.

⛳️ Requirements

• Licensed Registered Nurse (RN) – Ohio, or Licensed Social Worker (LSW or LISW) – Ohio, or Licensed Professional Counselor (LPC or LPCC) – Ohio.

• At least 1 year of paid experience in Home and Community-Based Services (HCBS).

• Experience in incident investigation, ensuring individual health and welfare, quality assurance or clinical risk management, mental health or addiction services, interfacing with relevant agencies, or providing waiver services.

• Strong critical-thinking and analytical capabilities.

• Excellent organizational skills with the ability to manage multiple investigations simultaneously.

• Exceptional verbal and written communication skills, including professional report writing.

• Proficient interviewing and active listening skills.

• Capacity to work independently as well as collaboratively within a team setting.

• Strong decision-making abilities, accuracy, and attention to detail.

• Professional demeanor and the ability to interact respectfully with individuals from diverse backgrounds.

• Proficiency in Microsoft Word, Excel, Outlook, and internet-based systems.

🏝️ Benefits

• Medical, dental, and vision insurance.

• 401(k) with discretionary employer match.

• Paid time off and holidays.

• Flexible spending accounts.

• Additional employee perks.