Healthcare Investigator

Staffing Solutions Organization LLC (SSO); Kentucky; Remote; USD 53,000 - 55,000; Full time

Benefits offered by this job

Quarterly performance bonuses

Medical, dental, and vision insurance

401(k) with discretionary employer/mat

Paid time off and holidays

Flexible spending accounts

Additional employee perks

Job summary

Staffing Solutions Organization LLC (SSO) seeks a Healthcare Investigator I for a fully remote Ohio-based role. License in RN, LSW/LISW, or LPC/LPCC required and at least 1 year in HCBS investigations or related areas.

The role involves examining incidents, reviewing records, interviewing stakeholders, and reporting findings while maintaining confidentiality. Occasional travel within Ohio may be possible.

Qualifications

• Licensed professionals in Ohio (RN/LSW/LISW/LPC/LPCC).
• At least 1 year in HCBS or related investigations.
• Strong documentation and reporting skills.

Responsibilities

• Investigate incidents involving Medicaid recipients/providers.
• Review clinical, billing, and incident documentation.
• Conduct interviews with involved parties.
• Document findings in the incident reporting system.
• Coordinate with law enforcement and regulatory bodies as needed.

Skills

Critical thinking

Analytical skills

Organization

Report writing

Interviewing

Independent work

Team collaboration

Decision making

Professionalism

MS Word

MS Excel

MS Outlook

Education

RN – Ohio

LSW/LISW – Ohio

LPC/LPCC – Ohio

Tools

Microsoft Word

Microsoft Excel

Outlook

Internet-based systems

Job description

Healthcare Investigator - State of Ohio (Multiple Openings)

Work Location: Remote – Must be a licensed LSW, RN, or LPC in the State of Ohio.

Pay Range: $53,000.00 - $55,000.00 annually

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.

Essential 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 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.

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) – Ohio
• Licensed Social Worker (LSW or LISW) – Ohio
• Licensed Professional Counselor (LPC or LPCC) – Ohio

Experience

• 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)

Work Environment

• Fully remote position within Ohio
• Occasional travel (1 to 2 times per year) within the Central Ohio area may be required for training
• May involve exposure to sensitive or emotionally challenging information
• Standard business hours with flexibility based on investigative needs

Benefits (Through SSO)

SSO offers a competitive benefits package that supports your health, financial well‑being, and long‑term growth, including:

• 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