Background Investigator

Summary

* Simple Staffing is hiring for this position on behalf of Staffing Solutions Organization LLC *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.Pay Range $48,000.00 - $55,000.00 annuallyEssential 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 enforcementCounty children servicesAdult Protective ServicesCounty Boards of Developmental DisabilitiesOther oversight or regulatory agenciesGathers information and prepares referrals to the Ohio Department of Medicaid for suspected or egregious provider misconduct.Maintains professionalism and confidentiality while working independently in a remote environment.Performs other duties as assigned to support departmental needs.Required Knowledge, Skills, & Abilities: Strong critical‑thinking and analytical skills with the ability to synthesize complex information.Excellent organizational skills with 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 with a high level of accuracy and attention to detail.Demonstrated professionalism and ability to work respectfully with individuals from diverse backgrounds.Proficiency with Microsoft Word, Excel, Outlook, and internet‑based systems.Minimum Qualifications: Education / Licensure (One Required) Licensed Registered Nurse (RN) – OhioLicensed Social Worker (LSW or LISW) – OhioLicensed Professional Counselor (LPC or LPCC) – OhioExperience Minimum of 1 year of paid experience in Home and Community‑Based Services (HCBS), including one or more of the following:Incident investigationEnsuring individual health and welfareQuality assurance or clinical risk managementMental health or addiction servicesInterfacing with law enforcement, nursing homes, children services, adult protective services, or the Ohio Department of Developmental DisabilitiesProviding waiver services (e.g., home health or other HCBS services)Work Environment Fully remote position within OhioOccasional travel (1 to 2 times per year) within the Central Ohio area may be required for trainingMay involve exposure to sensitive or emotionally challenging informationStandard business hours with flexibility based on investigative needsBenefits (Through SSO) SSO offers a competitive benefits package that supports your health, financial well‑being, and long‑term growth, including:Medical, dental, and vision insurance401(k) with discretionary employer matchPaid time off and holidaysFlexible spending accountsAdditional employee perksEducation / Licensure (One Required) Licensed Registered Nurse (RN) – OhioLicensed Social Worker (LSW or LISW) – OhioLicensed Professional Counselor (LPC or LPCC) – OhioExperience Minimum of 1 year of paid experience in Home and Community‑Based Services (HCBS), including one or more of the following:Incident investigationEnsuring individual health and welfareQuality assurance or clinical risk managementMental health or addiction servicesInterfacing with law enforcement, nursing homes, children services, adult protective services, or the Ohio Department of Developmental DisabilitiesProviding waiver services (e.g., home health or other HCBS services)Health insurance, Paid time off, Dental insurance, 401(k), Vision insurance, 401(k) matching#J-18808-Ljbffr

Job Description

* Simple Staffing is hiring for this position on behalf of Staffing Solutions Organization LLC *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.Pay Range $48,000.00 - $55,000.00 annuallyEssential 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 enforcementCounty children servicesAdult Protective ServicesCounty Boards of Developmental DisabilitiesOther oversight or regulatory agenciesGathers information and prepares referrals to the Ohio Department of Medicaid for suspected or egregious provider misconduct.Maintains professionalism and confidentiality while working independently in a remote environment.Performs other duties as assigned to support departmental needs.Required Knowledge, Skills, & Abilities: Strong critical‑thinking and analytical skills with the ability to synthesize complex information.Excellent organizational skills with 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 with a high level of accuracy and attention to detail.Demonstrated professionalism and ability to work respectfully with individuals from diverse backgrounds.Proficiency with Microsoft Word, Excel, Outlook, and internet‑based systems.Minimum Qualifications: Education / Licensure (One Required) Licensed Registered Nurse (RN) – OhioLicensed Social Worker (LSW or LISW) – OhioLicensed Professional Counselor (LPC or LPCC) – OhioExperience Minimum of 1 year of paid experience in Home and Community‑Based Services (HCBS), including one or more of the following:Incident investigationEnsuring individual health and welfareQuality assurance or clinical risk managementMental health or addiction servicesInterfacing with law enforcement, nursing homes, children services, adult protective services, or the Ohio Department of Developmental DisabilitiesProviding waiver services (e.g., home health or other HCBS services)Work Environment Fully remote position within OhioOccasional travel (1 to 2 times per year) within the Central Ohio area may be required for trainingMay involve exposure to sensitive or emotionally challenging informationStandard business hours with flexibility based on investigative needsBenefits (Through SSO) SSO offers a competitive benefits package that supports your health, financial well‑being, and long‑term growth, including:Medical, dental, and vision insurance401(k) with discretionary employer matchPaid time off and holidaysFlexible spending accountsAdditional employee perksEducation / Licensure (One Required) Licensed Registered Nurse (RN) – OhioLicensed Social Worker (LSW or LISW) – OhioLicensed Professional Counselor (LPC or LPCC) – OhioExperience Minimum of 1 year of paid experience in Home and Community‑Based Services (HCBS), including one or more of the following:Incident investigationEnsuring individual health and welfareQuality assurance or clinical risk managementMental health or addiction servicesInterfacing with law enforcement, nursing homes, children services, adult protective services, or the Ohio Department of Developmental DisabilitiesProviding waiver services (e.g., home health or other HCBS services)Health insurance, Paid time off, Dental insurance, 401(k), Vision insurance, 401(k) matching#J-18808-Ljbffr