Position Title: Incident Investigator
Location: Remote OH Duration: 6 months (possibility to extend or convert to FTE) Pay rate: $40-45.00/hr Schedule:
• Training: Mon Fri, 8am 5pm EST (approx. 4 weeks, no time off permitted during training)
• Regular: Mon Fri, 8am 5pm EST
• No weekends or holidays; overtime only if required
Summary: The Incident Investigator is responsible for the development, implementation, resolution, and oversight of waiver incident reporting at both the member and organizational levels. Job Responsibilities:
• Submit critical incidents into the Ohio Department of Medicaid Incident Management System (IMS) within required timelines.
• Review claims data, clinical data, case management notes, and assessments to substantiate or unsubstantiate incidents.
• Collaborate with care coordination staff, CMEs, and law enforcement to ensure accurate case resolution.
• Close cases within 45 days and insert appropriate prevention plans into IMS within 7 business days.
• Provide incident reporting education and support to internal and external stakeholders.
• Maintain compliance with CMS and Ohio Administrative Code requirements.
Job Requirements:
• Education: Degree in Nursing, Social Work, or Counseling.
• Licensure: RN, LSW, LISW, LPC, or LPCC (Ohio license required).
• Experience: Minimum 5 years in field of licensure with clinical experience. Knowledge of Ohio's MyCare Waiver, Medicaid products, and incident reporting process required.
Skills:
• Strong critical thinking and ability to work independently.
• Proficiency in Microsoft Office Suite (Excel, Word, Outlook) and Teams.
• Technical agility to navigate multiple systems quickly.
• Applications Trucare, OH incident management system, impact pro,
• Microsoft teams, outlook, excel, word
Preferred Qualities: Quick learner, accountable, collaborative team player, adaptable to independent work. Managed care experience is a plus.