[Hiring] Registered Nurse Healthcare Investigator @Staffing Solutions Organization LLC (SSO)

Role Description

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.

• 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 Protective Services
  • County Boards of Developmental Disabilities
  • Other oversight or regulatory agencies
• Gathers 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.

Qualifications

• Licensed Registered Nurse (RN) – Ohio

Requirements

• Minimum of 1 year of paid experience in Home and Community‑Based Services (HCBS), including one or more of the following:
  • Incident investigation
  • Ensuring individual health and welfare
  • Quality assurance or clinical risk management
  • Mental health or addiction services
  • Interfacing with law enforcement, nursing homes, children services, adult protective services, or the Ohio Department of Developmental Disabilities
  • Providing waiver services (e.g., home health or other HCBS services)

Benefits

• Quarterly performance bonuses
• Medical, dental, and vision insurance
• 401(k) with discretionary employer match
• Paid time off and holidays
• Flexible spending accounts
• Additional employee perks