Healthcare Investigator

Healthcare Investigator - State of Ohio (Multiple Openings) Work Location: Remote -- Must be a licensed LSW, RN, or LPC in the State of Ohio. Pay Range : $53,000.00 - $55,000.00 annually Once Healthcare Investigators have been thoroughly trained and are completing investigations independently (typically around 9 months), they are eligible for a quarterly bonus. - Bonuses are based on quarterly performance: productivity, quality, and taking on additional responsibilities. - Criteria for bonuses is shared with the investigator when they become bonus-eligible so they can work toward their own personal bonus goal. ------------------------------------------------------------------------ Position Summary The Healthcare Investigator I is responsible for investigating incidents involving Medicaid recipients and/or providers to ensure the health, safety, and welfare of individuals receiving services. This role conducts thorough investigations, coordinates with internal and external stakeholders, and ensures compliance with Ohio Medicaid and HCBS regulations. ------------------------------------------------------------------------ Essential Duties & Responsibilities Conducts investigations of reported incidents involving Medicaid recipients and providers to ensure health and welfare standards are met. Reviews and analyzes documentation including clinical records, incident reports, billing records, and other relevant materials. Performs interviews with recipients, providers, witnesses, and other involved parties using effective interviewing and active-listening techniques. Accurately documents all investigative activities, findings, and conclusions in the incident reporting system. Identifies rule violations, contributing factors, and potential risks; develops clear, well-supported investigation summary reports. Educates Medicaid providers on applicable rules, responsibilities, and best practices related to service delivery. Coordinates and refers cases to external entities as appropriate, including: Law enforcement County children services Adult Protectiv