Healthcare Compliance Investigator

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 I Work Location: Remote – Must be Licensed in the State of Ohio

Position Summary The Healthcare Compliance 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:

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

Compensation for roles at Staffing Solutions Organization LLC (SSO) varies depending on a wide array of factors including, but not limited to, the specific office location, role, skill set, and level of experience. As required by applicable law, SSO provides a reasonable range of compensation for this role. In addition, SSO provides a range of benefits for this role.

Applicants must be authorized to work in the U.S. This position is not eligible for work authorization sponsorship (including H-1B sponsorship) by SSO and under the federal laws relating to the F-1 STEM EAD program, this position is not eligible to support a STEM EAD extension application.

All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, gender identity, marital status, age, national origin, protected veteran status, or disability. Staffing Solutions Organization LLC is an E-Verify participant.