Healthcare Investigator

Staffing Solutions Organization LLCMedicaid HCBS

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 Excel

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: incident investigation; individual health and welfare; quality assurance or clinical risk management; mental health or addiction services; interfacing with relevant public agencies or care providers; or providing waiver services.
Demonstrate critical-thinking and analytical skills, including the ability to synthesize complex information.
Have organizational skills to manage multiple investigations concurrently.
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 within a team.
Demonstrate sound decision-making, accuracy, and attention to detail.
Work professionally and respectfully with individuals from diverse backgrounds.
Be proficient with Microsoft Word, Excel, Outlook, and internet-based systems.
Work standard business hours, with flexibility based on investigative needs.

Investigate reported incidents involving Medicaid recipients and providers to ensure health and welfare standards are met.
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, county children services, Adult Protective Services, County Boards of Developmental Disabilities, and other oversight agencies.
Gather information and prepare referrals to the Ohio Department of Medicaid concerning suspected or egregious provider misconduct.

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