Licensed Social Worker – Healthcare Investigator

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

📋 Description

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

• Examine and assess clinical records, incident reports, billing documentation, and other relevant materials.

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

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

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

• Create concise and well-supported investigation summary reports.

• Provide education to Medicaid providers regarding applicable regulations, 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 agencies.

• 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 additional duties as assigned.

⛳️ Requirements

• Must hold a valid LSW license in the State of Ohio; the posting also accepts an Ohio RN, LPC, LPCC, or LISW.

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

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

• Strong critical thinking and analytical abilities.

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

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

• Effective interviewing skills and active listening capabilities.

• Ability to work both independently and collaboratively.

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

• Professionalism and respect in working with diverse individuals.

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

• Availability to work standard business hours with flexibility based on investigative requirements.

🏝️ Benefits

• Quarterly performance bonuses.

• Medical, dental, and vision insurance.

• 401(k) with discretionary employer match.

• Paid time off and holidays.

• Flexible spending accounts.

• Additional employee perks.