Healthcare Investigator

Simple Staffing•Toledo, OH

1d•Remote

About The Position

Simple Staffing is hiring on behalf of Staffing Solutions Organization LLC for a Healthcare Investigator I. The role investigates incidents involving Medicaid recipients and/or providers to help ensure the health, safety, and welfare of individuals receiving services. The investigator conducts thorough investigations, coordinates with internal and external stakeholders, and supports compliance with Ohio Medicaid and HCBS regulations. This is a fully remote position within Ohio, with occasional travel (one to two times per year) within Central Ohio potentially required for training. The position may involve sensitive or emotionally challenging information. Work is generally during standard business hours, with flexibility based on investigative needs. The annual pay range is $48,000 to $55,000.

Requirements

Hold one of the following Ohio licenses: Registered Nurse (RN), Licensed Social Worker (LSW or LISW), or Licensed Professional Counselor (LPC or LPCC).
Have at least one year of paid experience in Home and Community-Based Services (HCBS), including experience in one or more of the following areas: 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 such as home health or other HCBS services.
Strong critical-thinking and analytical skills, including the ability to synthesize complex information.
Strong 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.

Responsibilities

Investigate reported incidents involving Medicaid recipients and providers to ensure health and welfare standards are met.
Review and analyze clinical records, incident reports, billing records, and other relevant documentation.
Interview recipients, providers, witnesses, and other involved parties using effective interviewing and active-listening techniques.
Document investigative activities, findings, and conclusions in the incident reporting system.
Identify rule violations, contributing factors, and potential risks, and prepare clear, well-supported investigation summary reports.
Educate Medicaid providers on applicable rules, responsibilities, and best practices related to service delivery.
Coordinate cases and make referrals to law enforcement, county children services, Adult Protective Services, County Boards of Developmental Disabilities, and other oversight or regulatory agencies as appropriate.
Gather information and prepare referrals to the Ohio Department of Medicaid regarding suspected or egregious provider misconduct.
Maintain professionalism and confidentiality while working independently in a remote environment.
Perform other duties as assigned to support departmental needs.