HCBS Incident Investigator

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future.

Position Purpose

This role will be responsible for the development, implementation, investigation, monitoring, and oversight of incident reporting at the member and organizational level. The primary functions will include incident reporting identification, investigation, inter-departmental coordination, and external partnership collaboration. This position ensures Buckeye's compliance with our contractual and regulatory requirements, including but not limited to, Centers for Medicare Services (CMS), the Ohio Department of Medicaid (ODM), and the Ohio Administrative Code (OAC).

• Development, coordination, and maintenance of initial and ongoing education as it pertains to Incident Reporting in accordance with regulatory requirements.
• Identification, investigation, and processing of incidents, as applicable, and in alignment with state/federal regulations (Abuse, neglect, misappropriation, exploitation, health, and welfare, among others).
• Collaboration of Incident Management with state-contracted investigation organization.
• Investigation of incidents that do not fall to the stated contracted investigation organization.
• Oversight of prevention plan determination and resolution.
• Audit Incidents to assure compliance and alignment for annual state/federal audit.
• Collects and reviews clinical documentation and makes a determination of substantiation based on investigation.
• Performs other duties as assigned.
• Complies with all policies and standards.

Requirements

• A degree in Nursing, Social Work, and/or Counseling.
• Five years of experience required.
• Must have knowledge of LTSS, Waiver, and Incident Reporting.

Qualifications

Preferred qualifications are bachelor’s in nursing and master’s in social work and/or Counseling.

• RN, LSW, LISW, LPC, or LPCC required.

Pay

Pay Range: $70,100.00 - $126,200.00 per year

Benefits

Centene offers a comprehensive benefits package including:

• Competitive pay, adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status.
• Health insurance.
• 401K and stock purchase plans.
• Tuition reimbursement.
• Paid time off plus holidays.
• A flexible approach to work with remote, hybrid, field, or office work schedules.
• Additional forms of incentives may be included in total compensation.

Benefits may be subject to program eligibility.