Healthcare Investigator

Simple Staffing Group

. Conduct investigations of reported incidents involving Medicaid recipients and providers .

Posted 10/17/2026full-timeRemote • Ohio • United StatesJunior💰 $48,000 - $55,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in conducting investigations related to Medicaid incidents, including analyzing clinical records and documenting findings. Proficient in educating providers on compliance and best practices while maintaining professionalism and confidentiality.

Highest-signal resume keywords

Licensed Registered Nurse (RN) – OhioLicensed Social Worker (LSW or LISW) – OhioLicensed Professional Counselor (LPC or LPCC) – OhioIncident Investigation ExperienceHome and Community-Based Services (HCBS) Experience

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Incident InvestigationClinical Risk ManagementQuality AssuranceReport WritingCritical ThinkingAnalytical SkillsInterviewing SkillsActive ListeningDecision-MakingAttention to Detail

Soft Skills

Organizational SkillsProfessionalismCollaborationCommunication Skills

Tools & Technologies

Microsoft WordMicrosoft ExcelMicrosoft OutlookInternet-Based Systems

Certifications & Qualifications

Licensed Registered Nurse (RN) – OhioLicensed Social Worker (LSW or LISW) – OhioLicensed Professional Counselor (LPC or LPCC) – Ohio

Industry Keywords

MedicaidHome and Community-Based Services (HCBS)Law Enforcement CoordinationAdult Protective ServicesQuality AssuranceClinical RecordsIncident ReportsBilling RecordsProvider MisconductService-Delivery Best Practices

About the role

Key responsibilities & impact

Conduct investigations of reported incidents involving Medicaid recipients and providers
Review and analyze clinical records, incident reports, billing records, and other relevant documentation
Interview recipients, providers, witnesses, and other involved parties
Document investigative activities, findings, and conclusions in the incident reporting system
Identify rule violations, contributing factors, and potential risks
Develop clear, well-supported investigation summary reports
Educate Medicaid providers on applicable rules, responsibilities, and service-delivery best practices
Coordinate and refer cases to law enforcement, county children services, Adult Protective Services, county boards of developmental disabilities, and other oversight or regulatory agencies
Gather information and prepare referrals to the Ohio Department of Medicaid for suspected or egregious provider misconduct
Maintain professionalism and confidentiality while working independently in a remote environment
Perform other duties as assigned
Occasional travel within the Central Ohio area may be required for training

Requirements

What you’ll need

Licensed Registered Nurse (RN) – Ohio, or Licensed Social Worker (LSW or LISW) – Ohio, or Licensed Professional Counselor (LPC or LPCC) – Ohio
Minimum of 1 year of paid experience in Home and Community-Based Services (HCBS)
Experience in incident investigation, ensuring individual health and welfare, quality assurance or clinical risk management, mental health or addiction services, interfacing with law enforcement or relevant agencies, or providing waiver services
Strong critical-thinking and analytical skills
Excellent organizational skills and 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
Strong decision-making skills, accuracy, and attention to detail
Professionalism and ability to work respectfully with individuals from diverse backgrounds
Proficiency with Microsoft Word, Excel, Outlook, and internet-based systems

Benefits

Comp & perks

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