Healthcare Investigator

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

📋 Description

• Conducts thorough investigations into incidents reported by Medicaid recipients and providers.

• Reviews and evaluates documentation, which includes clinical records, incident reports, and billing information.

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

• Accurately records all investigative actions and findings.

• Identifies violations of regulations and creates comprehensive investigation reports.

• Provides education to Medicaid providers regarding relevant rules and best practices.

• Coordinates and refers cases to external organizations as necessary.

• Collects information for referrals to the Ohio Department of Medicaid.

⛳️ Requirements

• Active Licensed Registered Nurse (RN) in Ohio.

• Active Licensed Social Worker (LSW or LISW) in Ohio.

• Active Licensed Professional Counselor (LPC or LPCC) in Ohio.

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

• Strong critical-thinking and analytical abilities.

• Excellent organizational capabilities.

• Proficient verbal and written communication skills.

🏝️ Benefits

• Medical, dental, and vision insurance.

• 401(k) with discretionary employer matching.

• Paid time off and holidays.

• Flexible spending accounts.

• Additional employee perks.