Hospital Investigator

Arizona Department of Health Services; Phoenix (AZ); On-site; USD 48,000 - 65,000; Full time

Benefits offered by this job

Medical Insurance

Paid Vacation and Sick Time

Paid Parental Leave

Job summary

Arizona Department of Health Services in Phoenix seeks a Hospital Investigator to conduct complex internal investigations related to patient rights violations and regulatory compliance at the Arizona State Hospital.

You will prepare written reports, testify at hearings, perform audits, and coordinate with CMS, Joint Commission, and other agencies. A background in law, health care compliance, or behavioral health is preferred.

Qualifications

• Experience in investigations and regulatory compliance.
• Knowledge of CMS/JCAO or related healthcare regulations.
• Ability to prepare concise investigation reports and present findings.

Responsibilities

• Lead internal investigations and interviews with staff, patients, and witnesses.
• Perform audits to identify regulatory and operational risks.
• Provide testimony and supporting documentation for hearings and legal proceedings.
• Coordinate with CMS, Joint Commission, and other regulators.

Skills

Interviewing

Data analysis

Oral communication

Regulatory knowledge

Education

High School diploma or equivalent

Bachelor's degree in psychology or related field

Tools

MS Office

Job description

DEPT OF HEALTH SERVICES

The Arizona State Hospital (ASH) provides inpatient psychiatric care to persons with serious mental illness who need long-term behavioral health care. ASH promotes hope and wellness for our patients and creates opportunities to participate in planning, delivering and evaluating services that assist with recovery. Treatment is individualized with goals that focus on education about an illness, instilling hope and improving one's overall quality of life. The Arizona State Hospital has a wide range of positions available, from our direct care staff, Nurses and Behavioral Health Technicians to Social Workers, Rehabilitation Specialist and Security to name a few. The Arizona State Hospital also offers 12 hour shifts for our Direct Care staff as well as some alternative work schedules, flexible hours for non-direct care staff. We offer a robust benefit package, including the ADHS Student Loan Assistance Program where eligible employees can receive up to $437.50 per month for their outstanding student loans.

Hospital Investigator

Job Location:

ARIZONA STATE HOSPITAL

Address: 150 N. 24th Street Phoenix, AZ 85008

Posting Details

Salary: $56,500

Grade: 20

Closing Date: Open Until Filled

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). This position also investigates allegations of rights violations related to behavioral health services for patients determined to have a serious mental illness (SMI), in accordance with Arizona Administrative Code (A.A.C.) Title 9, Chapter 21. The Hospital Investigator prepares a written report of their findings at the conclusion of their investigation for presentation to the Complaint, Grievance and Appeal Committee, keeping in accordance with time frames established in the AAC Title 9 Chapter 21 and Hospital policy. This position will also assist in the mediation of SMI appeals associated with a patients behavioral health services in accordance with AAC Title 9 Chapter 21. As applicable, this position may testify at administrative hearings as an official witness. The Hospital Investigator may perform compliance reviews as related to regulatory issues according to local, state and federal regulations. This position will perform audits based upon the findings from the complaints, SMI grievances or compliance reviews. This position works closely with the Hospital Patient Right Advocate, Hospital direct care staff, Hospital Leadership, ADOA Ombudsman, patients, patient guardians, contractors, and when applicable, outside agencies. This position will also assist with complaint investigations and/or surveys by the ADHS Medical Division of Licensing, Centers for Medicare and Medicaid Services, and the Joint Commission.

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. Conducts 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.
• Perform 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. Detailed audit report will be drafted 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.
• Other duties as assigned as related to the position (typically 5% - 10%)

Knowledge, Skills & Abilities (KSAs)

Knowledge

• 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.

Skill

• 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.
• Support a diverse multi-cultural workforce that reflects the community, promotes equal opportunity at all levels of public employment, and creates an inclusive work environment that enables all individuals to perform to their fullest potential free from discrimination.

Selective Preference(s)

• High School diploma or equivalent. Bachelors degree in psychology, sociology, criminal justice, administrative law, or healthcare compliance or three (3) years experience in related field. In addition with three (3) years experience in a behavioral health setting.

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.

• 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.

If this position requires driving or the use of a vehicle as an essential function of the job to conduct State business, then the following requirements apply: Driver’s License Requirements.

All newly hired State employees are subject to and must successfully complete the Electronic Employment Eligibility Verification Program (E-Verify).

Benefits

The State of Arizona provides an excellent comprehensive benefits package including:

• − 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

Learn more about the Paid Parental Leave program here. For a complete list of benefits provided by The State of Arizona, please visit our benefits page

Retirement

To help you build a financially secure future, the State makes monthly contributions to finance your retirement benefit. The State will make a contribution to the ASRS in an amount equal to your contribution. In other words, you and the State will each pay 50% of the total cost of the benefit. New State employees have a 27 week wait period for contributions to begin.

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 [phone]. Requests should be made as early as possible to allow sufficient time to arrange the accommodation. DHS is an Equal Employment Opportunity Employer. All newly hired employees will be subject to E-Verify Employment Eligibility Verification.