Registered Nurse - Healthcare Investigator
About The Position
The Healthcare Investigator I investigates incidents involving Medicaid recipients and/or providers to ensure the health, safety, and welfare of individuals receiving services. The position conducts thorough investigations, coordinates with internal and external stakeholders, and ensures compliance with Ohio Medicaid and HCBS regulations. The role is fully remote within Ohio and requires an Ohio-licensed RN. Occasional travel within Central Ohio, approximately one to two times per year, may be required for training. The position may involve sensitive or emotionally challenging information and follows standard business hours, with flexibility based on investigative needs.
Requirements
- Licensed Registered Nurse (RN) in Ohio.
- At least one year of paid experience in Home and Community-Based Services (HCBS).
- Strong critical-thinking and analytical skills, including the ability to synthesize complex information.
- Organizational skills and the 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 the ability to work respectfully with individuals from diverse backgrounds.
- Proficiency with Microsoft Word, Excel, Outlook, and internet-based systems.
- HCBS experience must include 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.
- Applicants must be authorized to work in the U.S.; the position is not eligible for work-authorization sponsorship or support for a STEM EAD extension application.
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 accurately in the incident reporting system.
- Identify rule violations, contributing factors, and potential risks, and prepare clear, well-supported investigation summary reports.
- Educate Medicaid providers about 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 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.
Benefits
- Quarterly performance bonuses
- Medical insurance
- Dental insurance
- Vision insurance
- 401(k) with discretionary employer match
- Paid time off
- Paid holidays
- Flexible spending accounts
- Additional employee perks
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
No Education Listed
