Licensed Social Worker - Healthcare Investigator

Staffing Solutions Organization LLC (SSO)

1d•$53,000 - $55,000•Remote

About The Position

The Healthcare Investigator I investigates incidents involving Medicaid recipients and/or providers to help ensure the health, safety, and welfare of people receiving services and compliance with Ohio Medicaid and HCBS regulations. The investigator reviews clinical records, incident reports, billing records, and other relevant documentation; interviews recipients, providers, witnesses, and other involved parties; and records investigative activities, findings, and conclusions in the incident reporting system. The role identifies rule violations, contributing factors, and potential risks, and produces clear, well-supported investigation reports. It also educates Medicaid providers about applicable rules and service-delivery responsibilities, coordinates referrals to appropriate external agencies, and prepares information for referrals to the Ohio Department of Medicaid concerning suspected or egregious provider misconduct. The position is fully remote within Ohio, with occasional Central Ohio travel for training. It may involve sensitive or emotionally challenging information and follows standard business hours with flexibility based on investigative needs.

Requirements

Hold an Ohio license as a Registered Nurse (RN), Social Worker (LSW or LISW), or Professional Counselor (LPC or LPCC).
Have at least 1 year of paid experience in Home and Community-Based Services (HCBS), including one or more of the following: 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.
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.
Must be authorized to work in the U.S.; the role is not eligible for work authorization sponsorship or F-1 STEM EAD extension support.

Responsibilities

Investigate reported incidents involving Medicaid recipients and providers to assess whether 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 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 as appropriate.
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 to support departmental needs.