Healthcare Investigator
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Job Description
Healthcare Investigator examining Medicaid recipient and provider incidents for Ohio’s health and human services system. Conducting interviews, analyzing records, and preparing regulatory referrals remotely within Ohio.
Responsibilities:
- Conduct investigations of reported incidents involving Medicaid recipients and providers
- Review and analyze 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
- Develop 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 or regulatory agencies
- Gather information and prepare referrals to the Ohio Department of Medicaid for suspected or egregious provider misconduct
- Maintain professionalism and confidentiality while working independently in a remote environment
- Perform other duties as assigned
Requirements:
- Licensed Registered Nurse (RN) – Ohio, or Licensed Social Worker (LSW or LISW) – Ohio, or Licensed Professional Counselor (LPC or LPCC) – Ohio
- Minimum of 1 year of paid experience in Home and Community-Based Services (HCBS)
- Experience in incident investigation, ensuring individual health and welfare, quality assurance or clinical risk management, mental health or addiction services, interfacing with relevant agencies, or providing waiver services
- Strong critical-thinking and analytical skills
- Excellent organizational skills and ability to manage multiple investigations concurrently
- Strong verbal and written communication skills, including professional report writing
- Effective interviewing and active-listening abilities
- Ability to work independently and collaboratively within a team environment
- Strong decision-making skills, accuracy, and attention to detail
- Professionalism and ability to work respectfully with individuals from diverse backgrounds
- Proficiency with Microsoft Word, Excel, Outlook, and internet-based systems
Benefits:
- Medical, dental, and vision insurance
- 401(k) with discretionary employer match
- Paid time off and holidays
- Flexible spending accounts
- Additional employee perks
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