Healthcare Compliance Investigator

🔍 Protect Medicaid Members. Strengthen Provider Accountability. Work Remotely in Ohio.Healthcare Compliance Investigator I📍 Remote – Must reside and be licensed in the State of OhioAre you a licensed healthcare professional who’s passionate about protecting vulnerable populations and ensuring quality, compliant care? Join a mission‑driven team making a real impact across Ohio’s Medicaid and HCBS programs.🩺 Position SummaryThe Healthcare Compliance Investigator I plays a critical role in safeguarding the health, safety, and welfare of Medicaid recipients. In this role, you’ll investigate reported incidents involving recipients and providers, assess compliance with Ohio Medicaid and HCBS regulations, and collaborate with internal and external partners to ensure accountability and quality service delivery.This is a fully remote position (within Ohio) with meaningful, purpose‑driven work.✅ What You’ll DoConduct investigations into reported incidents involving Medicaid recipients and providersReview and analyze clinical records, incident reports, billing documentation, and related materialsInterview recipients, providers, witnesses, and other parties using effective investigative techniquesAccurately document findings, conclusions, and recommendations in the incident reporting systemIdentify rule violations, contributing factors, and risks; prepare clear, well‑supported investigation summariesEducate providers on Medicaid rules, responsibilities, and best practicesCoordinate and refer cases to external agencies as appropriate, including:Law enforcementCounty Children ServicesAdult Protective ServicesCounty Boards of Developmental DisabilitiesOther regulatory or oversight entitiesPrepare referrals to the Ohio Department of Medicaid for suspected or egregious misconductMaintain confidentiality and professionalism while working independently in a remote environmentSupport departmental initiatives and additional duties as assigned🧠 What You BringRequired Licensure (Ohio – one required):Registered Nurse (RN)Licensed Social Worker (LSW or LISW)Licensed Professional Counselor (LPC or LPCC)Experience:Minimum 1 year of paid experience in Home and Community‑Based Services (HCBS), including one or more of the following:Incident investigationsHealth and welfare oversightQuality assurance or clinical risk managementMental health or addiction servicesCollaboration with law enforcement, nursing homes, children services, APS, or DODDProviding waiver or HCBS services (e.g., home health)Key Skills:Strong analytical and critical‑thinking abilitiesExcellent written and verbal communication (professional report writing required)Strong organizational skills with the ability to manage multiple investigationsEffective interviewing and active‑listening skillsHigh attention to detail and sound judgementAbility to work independently and as part of a collaborative teamProficiency with Microsoft Word, Excel, Outlook, and web‑based systems💻 Work EnvironmentFully remote within the state of OhioOccasional travel (1–2 times per year) to Central Ohio for trainingStandard business hours with flexibility based on investigative needsExposure to sensitive or emotionally challenging information🎯 Benefits (Through SSO)Medical, dental, and vision insurance401(k) with discretionary employer matchPaid time off and holidaysFlexible spending accountsAdditional employee perksInterested in making an impact from day one? Apply today and help ensure quality, compliant care for Ohio’s Medicaid members.Keywords:Healthcare Compliance Investigator, Medicaid Investigations, HCBS, Ohio Medicaid, Remote Healthcare Jobs Ohio, RN Jobs Ohio, Social Work Jobs Ohio, LPC Jobs Ohio, Quality Assurance Healthcare, Clinical Compliance, Healthcare Risk Management, Medicaid Provider Oversight, Healthcare Investigations