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 Investigator - State of Ohio (Multiple Openings) Work Location: Remote – Must be a licensed LSW, RN, or LPC in the State of Ohio. Pay Range: $48,000.00 - $53,000.00 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