Hospital Investigator

Job Summary

The Hospital Investigator position serves as an internal investigator for the Arizona State Hospital (ASH). This position conducts complex, high-visibility, and legally sensitive investigations related to allegations of patient right violations or compliance concerns. The Hospital Investigator handles complaint investigations in accordance with regulatory requirements from the Arizona Department of Health Services (ADHS), Medical Facilities Licensing, Joint Commission and the Centers for Medicare and Medicaid Services (CMS).

Job Duties

• Serve as a subject matter expert in dispute resolution, clinical communication, and risk mitigation, conducting objective, thorough end-to-end investigations while safeguarding patient rights and organizational integrity.
• Cover interviews of witnesses, staff, patients, and other relevant individuals; reviews and processes data, documents, and medical records; drafts investigation reports, decision letters, appendixes, and maintains case file; maintains strict compliance with CMS regulations, Joint Commission standards, and state health department guidelines regarding grievance response timelines.
• Conduct complex internal audits to identify systemic operational vulnerabilities, clinical trends, and recurrent risk areas in accordance with regulatory requirements of the ADHS Medical Facilities Licensing, Joint Commission and CMS.
• Audits will include partnering Medical, Nursing and Clinical Leadership as Compliance, Quality, Legal and Health Records Departments to gather evidence, interview staff/patients, review of prior deficiencies, tracer activities, Hospital policy review, and patient chart reviews. Drafts detailed audit report with presentation of actionable findings in both written and oral format.
• Schedules and Mediates SMI appeal informal conferences while seeking resolution that would be acceptable by the patient. Completes a detailed report of the conference outlining the resolved and non-resolved issues.
• Provide witness testimony at administrative fair hearings before the Office of Administrative Hearings. Review the investigation report and supporting evidence and discuss the findings (interviews, records/documentation, surveillance, etc.) with legal counsel to prepare for testimony and cross examination.
• Perform other duties as assigned as related to the position (typically 5% - 10%).

Knowledge, Skills & Abilities (KSAs)

• Knowledge of civil and administrative law, federal Medicaid/Medicare statutes, rules and regulations as they relate to Title 19, United States Code and additional knowledge of Arizona Revised Statutes, Title 36 and Title 13.
• Knowledge of patients rights, along with Grievance and appeal procedures for Persons with Serious Mental Illness under Arizona Administrative Code Title 9, Chapter 21.
• Knowledge of medical terminology and procedures to review specific medical records.
• Knowledge of proper methods of interviewing victims, witnesses, and alleged perpetrators.
• Knowledge of investigative methods, techniques, and approaches necessary to plan and conduct investigations of a highly sensitive nature.
• Knowledge of legal compliance issues of confidentiality, release of records, release of information and subpoenas.
• Performance Management (PM), and Continuous Quality Improvement (CQI) and Lean methodologies.

Skills

• Oral and interpersonal communications necessary to conduct interviews to elicit pertinent information.
• Interact effectively with Hospital staff, patients, and if necessary, regulatory officials regarding investigatory matters.
• Analyzing qualitative and quantitative data.
• Interpreting State and Federal laws, rules ,and regulations.
• Preparing detailed and concise investigation reports that set forth the necessary elements to substantiate or unsubstantiated allegations.
• Interviewing techniques and preservation of data.
• Reviewing medical and case file charts.
• Use of databases, Microsoft Excel, Word, PowerPoint and Google products.

Ability

• Present information and ideas effectively.
• Summarize and communicate investigative findings in both oral and written format.
• Prioritize assignments and meet required deadlines.
• Communicate with patients and residents of ASH.
• Work independently with little supervision.
• Occasionally alter work hours to facilitate investigations.
• Operate efficiently under deadline pressures.
• Obtain information from potentially hostile or uncooperative individuals.
• Effectively and efficiently address sensitive issues during investigations.

Pre-Employment Requirements

• Valid AZ State Driver's License.
• A State Hospital employee must be able to obtain and maintain a valid Level one Fingerprint Clearance Card pursuant to A.R.S. 41-1758.07.
• This position requires National Certified Investigator and Inspector Training (NCIT) Basic through the Council on Licensure, Enforcement, and Regulation (CLEAR). This training may be completed after hire, but within one year of hire date.

Benefits

• Affordable medical and dental insurance plans.
• Paid vacation and sick time.
• Paid Parental Leave-Up to 12 weeks per year paid leave for newborn or newly-placed foster/adopted child (pilot program).
• 10 paid holidays per year.
• Wellness program and plans.
• Life insurance.
• Short/long-term disability insurance.
• Defined retirement plan.
• Award winning Infant at Work program.
• Credit union membership.
• Transit subsidy.
• ADHS Student Assistance Pilot Program

Contact Us

• The State of Arizona is an Equal Opportunity/Reasonable Accommodation Employer.
• Persons with a disability may request a reasonable accommodation such as a sign language interpreter or an alternative format by calling (602) 220-6462. Requests should be made as early as possible to allow sufficient time to arrange the accommodation.
• DHS is an Equal Employment Opportunity Employer.