Remote Medicaid Compliance Investigator (RN/LSW/LPC)

Staffing Solutions Organization LLC; Kentucky; On-site; USD 60,000 - 85,000; Full time

Benefits offered by this job

Medical, dental, and vision insurance

401(k) with discretionary match

Paid time off and holidays

Flexible spending accounts

Additional employee perks

Job summary

Staffing Solutions Organization LLC is seeking a Healthcare Investigator to safeguard Medicaid recipients across Ohio. This fully remote role investigates incidents, analyzes records, interviews involved parties, and documents findings to ensure compliance with HCBS regulations.

Ohio‑licensed professionals (RN/LISW/LPC) with HCBS experience, strong analytical skills, and the ability to work independently in a remote setting are preferred. Some travel to Central Ohio for training may be required.

Qualifications

• Must hold Ohio licensure (RN/LISW/LPC).
• Minimum 1 year in Home and Community‑Based Services (HCBS).
• Experience in incident investigations or risk management.
• Ability to work independently in a remote setting.
• Strong communication with diverse stakeholders.

Responsibilities

• Conduct investigations into reported incidents involving Medicaid recipients and providers.
• Review and analyze clinical records, incident reports, billing documentation, and related materials.
• Interview recipients, providers, witnesses, and other parties using effective investigative techniques.
• Accurately document findings, conclusions, and recommendations in the incident reporting system.
• Identify rule violations, contributing factors, and risks; prepare clear, well‑supported investigation summaries.
• Educate providers on Medicaid rules, responsibilities, and best practices.
• Coordinate referrals to external agencies (Law enforcement, APS, DODD, etc.).
• Prepare referrals to the Ohio Department of Medicaid for suspected misconduct.
• Maintain confidentiality and professionalism while working remotely.
• Support departmental initiatives and additional duties as assigned.

Skills

Analytical thinking

Organizational skills

Interviewing

Attention to detail

Independent work

MS Word/Excel/Outlook

Education

Ohio licensure (RN/LISW/LPC)

Tools

Microsoft Word

Microsoft Excel

Microsoft Outlook

Web-based systems

Job description

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

Are you a licensed healthcare professional who’s passionate about protecting vulnerable populations and ensuring quality, compliant care? Join a mission‑driven team making a real impact across Ohio’s Medicaid and HCBS programs.

Position Summary:

The Healthcare Investigator plays a critical role in safeguarding the health, safety, and welfare of Medicaid recipients. In this role, you’ll investigate reported incidents involving recipients and providers, assess compliance with Ohio Medicaid and HCBS regulations, and collaborate with internal and external partners to ensure accountability and quality service delivery.

This is a fully remote position with meaningful, purpose‑driven work.

What You’ll Do:

• Conduct investigations into reported incidents involving Medicaid recipients and providers
• Review and analyze clinical records, incident reports, billing documentation, and related materials
• Interview recipients, providers, witnesses, and other parties using effective investigative techniques
• Accurately document findings, conclusions, and recommendations in the incident reporting system
• Identify rule violations, contributing factors, and risks; prepare clear, well‑supported investigation summaries
• Educate providers on Medicaid rules, responsibilities, and best practices
• Coordinate and refer cases to external agencies as appropriate, including:
• Law enforcement
• Adult Protective Services
• County Boards of Developmental Disabilities
• Other regulatory or oversight entities
• Prepare referrals to the Ohio Department of Medicaid for suspected or egregious misconduct
• Maintain confidentiality and professionalism while working independently in a remote environment
• Support departmental initiatives and additional duties as assigned

What You Bring:

Required Licensure (Ohio – one required):

• Registered Nurse (RN)
• Licensed Social Worker (LSW or LISW)
• Licensed Professional Counselor (LPC or LPCC)

Experience:

• Minimum 1 year of paid experience in Home and Community‑Based Services (HCBS), including one or more of the following:
• Incident investigations
• Health and welfare oversight
• Quality assurance or clinical risk management
• Mental health or addiction services
• Collaboration with law enforcement, nursing homes, children services, APS, or DODD
• Providing waiver or HCBS services (e.g., home health)

Key Skills:

• Strong analytical and critical‑thinking abilities
• Strong organizational skills with the ability to manage multiple investigations
• Effective interviewing and active‑listening skills
• High attention to detail and sound judgement
• Ability to work independently and as part of a collaborative team
• Proficiency with Microsoft Word, Excel, Outlook, and web‑based systems
• Fully remote position
• Occasional travel (1–2 times per year) to Central Ohio for training
• Standard business hours with flexibility based on investigative needs
• Exposure to sensitive or emotionally challenging information

Benefits (Through SSO):

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

Interested in making an impact from day one? Apply today and help ensure quality, compliant care for Ohio’s Medicaid members.

Keywords:

Healthcare Compliance Investigator, Medicaid Investigations, HCBS, Ohio Medicaid, Remote Healthcare Jobs Ohio, RN Jobs Ohio, Social Work Jobs Ohio, LPC Jobs Ohio, Quality Assurance Healthcare, Clinical Compliance, Healthcare Risk Management, Medicaid Provider Oversight, Healthcare Investigations