Healthcare Investigator
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Staffing Solutions Organization LLCHealthcare services
Fully remote position within OhioFull-TimeJunior
Salary48,000 - 55,000 USD per year
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Job Details
- Experience
- Minimum of 1 year of paid experience in Home and Community-Based Services (HCBS)
- Required Skills
- Microsoft ExcelAnalytical SkillsCritical thinkingActive listening
Requirements
- Hold one of the following Ohio licenses: Registered Nurse (RN), Social Worker (LSW or LISW), or Professional Counselor (LPC or LPCC).
- Have a minimum of 1 year of paid experience in Home and Community-Based Services (HCBS).
- Have experience in at least one relevant area, such as incident investigation, individual health and welfare, quality assurance or clinical risk management, mental health or addiction services, interfacing with relevant agencies, or providing waiver services.
- Demonstrate critical-thinking and analytical skills, including the ability to synthesize complex information.
- Be able to manage multiple investigations concurrently and stay organized.
- Have strong verbal and written communication skills, including professional report writing.
- Demonstrate effective interviewing and active-listening abilities.
- Be able to work independently and collaboratively with a team.
- Demonstrate sound decision-making, accuracy, and attention to detail.
- Work respectfully and professionally with people from diverse backgrounds.
- Be proficient with Microsoft Word, Excel, Outlook, and internet-based systems.
Responsibilities
- Investigate reported incidents involving Medicaid recipients and providers to assess health and welfare standards.
- Review clinical records, incident reports, billing records, and other relevant documentation.
- Interview recipients, providers, witnesses, and other involved parties.
- Document investigative activities, findings, and conclusions in the incident reporting system.
- Identify rule violations, contributing factors, and potential risks, and prepare investigation summary reports.
- Educate Medicaid providers on applicable rules, responsibilities, and service-delivery best practices.
- Coordinate and refer cases to law enforcement, children services, Adult Protective Services, county developmental-disability boards, and other oversight agencies.
- Gather information and prepare referrals to the Ohio Department of Medicaid for suspected or egregious provider misconduct.
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