Registered Nurse - Healthcare Investigator

Registered Nurse Healthcare Investigator - State of Ohio Work Location: Remote - Must be a licensed RN 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 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: Registered Nurse (RN), Ohio RN, Licensed Registered Nurse, Staff Nurse, Case Management Nurse, Clinical Nurse, Healthcare Investigator, Medicaid Investigator, Incident Investigation, 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, Patient Safety, Clinical Documentation Review, Medical Record Review, Investigative Interviewing, Active Listening, Incident Reporting, Case Review, Regulatory Compliance, Provider Compliance, Root Cause Analysis, Risk Assessment, Corrective Action, Nursing Assessment, Care Coordination, Utilization Review, Home Health Nursing, Long-Term Care, Skilled Nursing, Behavioral Health, Mental Health Services, Addiction Services, Adult Protective Services (APS), Child Protective Services (CPS), County Boards of Developmental Disabilities (DD), Law Enforcement Collaboration, Vulnerable Populations, Provider Education, Evidence Gathering, Critical Thinking, Analytical Skills, Report Writing, Professional Documentation, Quality Improvement, Medicaid Program Integrity, Healthcare Quality Assurance, Nursing Home Experience, Waiver Services, Remote Work, Microsoft Office, Microsoft Excel, Microsoft Outlook, Ohio Healthcare Jobs, Ohio Nursing Jobs, Remote RN Jobs, Healthcare Compliance, Healthcare Quality, Case Management, Population Health, Managed Care, Care Management, Utilization Management, Clinical Operations, Registered Nurse Investigator. #J-18808-Ljbffr