Staffing Solutions Organization LLC (SSO), an affiliate of Public Consulting Group LLC (PCG), is focused on delighting clients with world-class managed staffing and talent consulting services. SSO is committed to a diverse workforce, which is a reflection of our clients and the people they serve.
HEALTHCARE COMPLIANCE INVESTIGATOR - OHIO
Duties & Responsibilities:
- Investigates incidents pertaining to Medicaid recipients and/or their providers with the purpose of ensuring health and welfare.
- Educates Medicaid providers of all applicable rules, responsibilities, and best practices related to providing services to Medicaid recipients.
- Conducts thorough investigations of all incidents and violations including a review of all relevant documentation, billing, and interviews with all individuals who may have relevant information, document all investigative activities, including discovery of all elements of the incident in the incident reporting system.
- Makes referrals to and coordinate investigations with law enforcement, county children's services, adult protective units, county board of developmental disabilities, or any other entity as needed.
- Writes investigation summary reports identifying all contributing factors and works with Case Manager to approve a prevention plan to mitigate risk and ensure health and welfare of the individual.
- Gathers information to write and submit referrals to Ohio Department of Medicaid for egregious provider behavior.
- All other duties as assigned per departmental need
Required Skills:
- Ability to think critically, incorporating multiple factors into larger concepts.
- Strong organizational skills with abilities to simultaneously manage multiple investigations.
- Ability to work with and relate to others with customer relation techniques, professionalism and with respect for other cultures.
- Ability to effectively use active listening and interviewing skills.
- Must be computer literate and have MS Word, Excel, Outlook, and Internet skills.
- Ability to foster teamwork with all levels of management and staff.
- Ability to work well independently and within a team.
- Superior verbal and written communication skills
- Strong decision-making skills, with accuracy and attention to detail
Qualifications:
- Education: Licensed registered nurse (RN), a licensed social worker (LSW, LISW), or a licensed professional counselor (LPC, LPCC)
- Experience: 1+ year paid experience in home and community-based service (HCBS), specifically experience with any of the following: incident investigation, assuring individual health and welfare, quality assurance, clinical risk management, the mental health system, or interfacing with law enforcement, nursing homes, children services, adult protective services, or the Department of Developmental Disabilities