Licensed Social Worker - Healthcare Investigator

Staffing Solutions Organization LLC (SSO); Ohio; 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 mix

Paid time off and holidays

Flexible spending accounts

Employee perks

Job summary

Staffing Solutions Organization LLC (SSO) seeks a Licensed Social Worker - Healthcare Investigator in Ohio. The role is fully remote within the state; you must be licensed as an LSW or LISW in Ohio.

The position involves investigating Medicaid-related incidents to protect the health and welfare of recipients, with strict documentation and coordination with external agencies. The incumbent will review records, conduct interviews, educate providers on compliance, and prepare detailed reports.

Qualifications

• Licensed LSW or LISW in Ohio.
• 1 year of paid HCBS experience including incident investigations, quality assurance or clinical risk management.
• Ability to interview effectively and document findings clearly.

Responsibilities

• Investigate incidents involving Medicaid recipients and providers to ensure welfare standards.
• Review documentation including clinical records, incident and billing records.
• Conduct interviews with recipients, providers, witnesses, and others using active listening.
• Document all investigative activities and prepare well-supported reports.
• Coordinate referrals to external agencies as appropriate (e.g., law enforcement, APS, DD boards).

Skills

Critical thinking

Analytical skills

Communication

Interviewing

Documentation

Independent work

Education

Licensed Social Worker (LSW) – OH

Licensed Independent Social Worker (LISW) – OH

Licensed Professional Counselor (LPC) – OH

Tools

MS Word

MS Excel

MS Outlook

Incident reporting system

Job description

Licensed Social Worker - Healthcare Investigator - State of Ohio

Work Location: Remote – Must be a licensed as an LSW 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

Keywords

Licensed Social Worker (LSW), Licensed Independent Social Worker (LISW), Ohio LSW, Ohio LISW, Social Worker, Healthcare Investigator, Medicaid Investigator, Incident Investigation, Incident Reporting, Compliance Investigation, Clinical Investigation, Home and Community-Based Services (HCBS), Ohio Medicaid, Medicaid Compliance, Medicaid Waiver Services, Long-Term Services and Supports (LTSS), Quality Assurance, Clinical Risk Management, Health & Welfare Monitoring, Investigative Interviewing, Active Listening, Report Writing, Case Review, Documentation Review, Medical Record Review, Provider Compliance, Regulatory Compliance, Root Cause Analysis, Risk Assessment, Corrective Action, Adult Protective Services (APS), Child Protective Services (CPS), County Boards of Developmental Disabilities (DD), Law Enforcement Collaboration, Mental Health Services, Addiction Services, Behavioral Health, Human Services, Vulnerable Populations, Case Management, Social Services, Provider Education, Evidence Gathering, Critical Thinking, Analytical Skills, Professional Documentation, Microsoft Office, Microsoft Excel, Microsoft Outlook, Remote Work, Ohio Healthcare Jobs, Healthcare Compliance, Patient Safety, Medicaid Program Integrity, Quality Improvement, Home Health Services, Developmental Disabilities Services.