Healthcare Investigator
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Job Description
Healthcare Investigator probing Medicaid incidents involving recipients and providers. Ensuring Ohio HCBS compliance through interviews, documentation, referrals, and investigative reports.
Responsibilities:
- Investigate reported incidents involving Medicaid recipients and providers
- Review and analyze clinical records, incident reports, billing records, and other 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
- Prepare clear, well-supported 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 law enforcement, nursing homes, children services, adult protective services, or the Ohio Department of Developmental Disabilities, 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 diverse individuals
- 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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