Healthcare Compliance Invest 2

Public Consulting Group•Raleigh, NC

12d•$65,000 - $95,000•Remote

About The Position

Public Consulting Group LLC (PCG) is a leading public sector solutions implementation and operations improvement firm that partners with health, education, and human services agencies to improve lives. Founded in 1986, PCG employs approximately 2,000 professionals throughout the U.S.—all committed to delivering solutions that change lives for the better. The firm is a member of a family of companies with experience in all 50 states, and clients in three Canadian provinces and Europe. PCG offers clients a multidisciplinary approach to meet challenges, pursue opportunities, and serve constituents across the public sector. To learn more, visit www.publicconsultinggroup.com .

Requirements

Demonstrated ability to think critically, incorporating multiple factors into larger concepts
Strong organizational skills with abilities to simultaneously manage multiple investigations
Demonstrated ability to work with and relate to others with customer relation techniques, professionalism and with respect for other cultures
Demonstrated effective active listening and interviewing skills
Strong computer skills with competence in MS Word, Excel, and Outlook
Demonstrated ability to foster teamwork with all levels of management and staff
Demonstrated ability to work well independently and within a team
Superior verbal and written communication skills
Strong and independent decision making skills, with accuracy and attention to detail
Ability to successfully work in multiple programs and projects.
Demonstrated excellent time management, initiative self-direction, and accountability
Licensed registered nurse (RN), a licensed social worker (LSW, LISW), or a licensed professional counselor (LPC, LPCC)
3+ years paid experience in home and community based service (HCBS), specifically experience with any of the following: incident investigation, assuring individual health and welfare, quality assurance, clinical risk management, the mental health system, or interfacing with law enforcement, nursing homes, children services, adult protective services, or the Department of Developmental Disabilities
RN, LSW, LISW, LPC, LPCC

Responsibilities

Assumes more difficult cases, bundles
Trains new investigators on managing work flow
Investigates incidents pertaining to Medicaid recipients and/or their providers with the purpose of ensuring health and welfare
Educates Medicaid providers of all applicable rules, responsibilities, and best practices related to providing services to Medicaid recipients
Conducts thorough investigations of all incidents and violations including a review of all relevant documentation, billing, and interviews with all individuals who may have relevant information, document all investigative activities, including discovery of all elements of the incident in the incident reporting system
Makes referrals to and coordinate investigations with law enforcement, county children's services, adult protective units, county board of developmental disabilities, or any other entity as needed
Writes investigation summary reports identifying all contributing factors and work with Case Manager to approve a prevention plan to mitigate risk and ensure health and welfare of the individual
Gathers information to write and submit referrals to Ohio Department of Medicaid for egregious provider behavior
All other duties as assigned per departmental need