Healthcare Investigator

Position Summary

The Healthcare Investigator plays a critical role in safeguarding the health, safety, and welfare of Medicaid recipients. In this role, you’ll investigate reported incidents involving recipients and providers, assess compliance with Ohio Medicaid and HCBS regulations, and collaborate with internal and external partners to ensure accountability and quality service delivery.

What You’ll Do

• Conduct investigations into reported incidents involving Medicaid recipients and providers
• Review and analyze clinical records, incident reports, billing documentation, and related materials
• Interview recipients, providers, witnesses, and other parties using effective investigative techniques
• Accurately document findings, conclusions, and recommendations in the incident reporting system
• Identify rule violations, contributing factors, and risks; prepare clear, well-supported investigation summaries
• Coordinate and refer cases to external agencies as appropriate, including:
• Law enforcement
• County Children Services
• Adult Protective Services
• County Boards of Developmental Disabilities
• Other regulatory or oversight entities
• Prepare referrals to the Ohio Department of Medicaid for suspected or egregious misconduct
• Maintain confidentiality and professionalism while working independently in a remote environment
• Support departmental initiatives and additional duties as assigned

What You Bring

• Required Licensure (Ohio – one required): Registered Nurse (RN), Licensed Social Worker (LSW or LISW), Licensed Professional Counselor (LPC or LPCC)
• Experience: Minimum 1 year of paid experience in Home and Community-Based Services (HCBS), including one or more of the following: Incident investigations, Health and welfare oversight, Quality assurance or clinical risk management, Mental health or addiction services, Collaboration with law enforcement, nursing homes, children services, APS, or DODD, Providing waiver or HCBS services (e.g., home health)

Key Skills

• Strong analytical and critical-thinking abilities
• Excellent written and verbal communication (professional report writing required)
• Strong organizational skills with the ability to manage multiple investigations
• Effective interviewing and active-listening skills
• High attention to detail and sound judgement
• Ability to work independently and as part of a collaborative team
• Proficiency with Microsoft Word, Excel, Outlook, and web-based systems

Work Environment

• Full-time remote position
• Occasional travel (1–2 times per year) to Central Ohio for training
• Standard business hours with flexibility based on investigative needs
• Exposure to sensitive or emotionally challenging information