Case Management, Clinical Data, Clinical Data Management, Clinical Medicine, Content Management Systems (CMS), IP Multimedia System (IMS), Incident Management, Law Enforcement, Maintain Compliance, Managed Care, Medicaid, Microsoft Excel, Microsoft Office, Microsoft Outlook, Microsoft Word, Registered Nurse (RN), Reporting Skills, Team Player
Position Title: Incident Investigator
Location: Remote OH
Duration: 6 months (possibility to extend or convert to FTE)
XXXX: XXXX-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.