Healthcare Investigator

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

📋 Description

• Investigate incidents reported by Medicaid recipients and providers to ensure compliance with health and welfare standards.

• Review and assess clinical records, incident reports, billing documentation, and other pertinent information.

• Conduct interviews with recipients, providers, witnesses, and other parties involved.

• Document investigative actions, findings, and conclusions within the incident reporting system.

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

• Prepare clear and well-supported summary reports of investigations.

• Educate Medicaid providers regarding relevant rules, responsibilities, and best practices in service delivery.

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

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

• Maintain professionalism and confidentiality while working autonomously in a remote setting.

• Perform additional duties as necessary to support departmental objectives.

⛳️ Requirements

• Possession of one of the following Ohio licenses: Registered Nurse (RN), Social Worker (LSW or LISW), or Professional Counselor (LPC or LPCC).

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

• Experience in incident investigation, individual health and welfare, quality assurance, clinical risk management, mental health or addiction services, relevant agency coordination, or waiver services.

• Strong critical-thinking and analytical skills.

• Ability to synthesize complex information effectively.

• Excellent organizational abilities and capability to manage multiple investigations simultaneously.

• Strong verbal and written communication skills, including proficiency in professional report writing.

• Effective interviewing and active listening skills.

• Capacity to work both independently and collaboratively within a team.

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

• Demonstrated professionalism and ability to work respectfully with diverse individuals.

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

• Must reside and work within Ohio.

• Willingness to accommodate occasional travel 1–2 times per year within Central Ohio for training purposes.

• Ability to work standard business hours with flexibility according to investigative requirements.

• Capacity to handle sensitive or emotionally difficult information.

🏝️ Benefits

• Medical, dental, and vision insurance.

• 401(k) with discretionary employer matching.

• Paid time off and holidays.

• Flexible spending accounts.

• Additional employee perks.

• Flexible scheduling based on investigative needs.