Public Consulting Group

Healthcare Compliance Investigator

Job Locations US-OH | US
Posted Date 4 months ago(1/24/2022 4:41 PM)
Job ID
# of Openings
Clinical Review
Regular Full-Time
Practice Area
Health Services


Healthcare Compliance Investigator in Ohio


Staffing Solutions Organization LLC (SSO), a wholly owned subsidiary of Public Consulting Group, 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.


Duties and Responsibilities:

  • Investigates incidents pertaining to Medicaid recipients and/or their providers with the purpose of ensuring health and welfare
  • Educates Medicaid providers of all applicable rules, responsibilities, and best practices related to providing services to Medicaid recipients 
  • Conducts thorough investigations of all incidents and violations including a review of all relevant documentation, billing, and interviews with all individuals who may have relevant information, document all investigative activities, including discovery of all elements of the incident in the incident reporting system
  • Makes referrals to and coordinate investigations with law enforcement, county children's services, adult protective units, county board of developmental disabilities, or any other entity as needed
  • Writes investigation summary reports identifying all contributing factors and work with Case Manager to approve a prevention plan to mitigate risk and ensure health and welfare of the individual
  • Gathers information to write and submit referrals to Ohio Department of Medicaid for egregious provider behavior
  • All other duties as assigned per departmental need

Required Skills:

  • Ability to think critically, incorporating multiple factors into larger concepts
  • Strong organizational skills with abilities to simultaneously manage multiple investigations
  • Ability to work with and relate to others with customer relation techniques, professionalism and with respect for other cultures
  • Ability to effectively use active listening and interviewing skills
  • Must be computer literate and have MS Word, Excel, Outlook, and Internet skills
  • Ability to foster teamwork with all levels of management and staff
  • Ability to work well independently and within a team
  • Superior verbal and written communication skills
  • Strong decision making skills, with accuracy and attention to detail




Education(s):       Licensed registered nurse (RN), a licensed social worker (LSW, LISW), or a licensed professional counselor (LPC, LPCC) (Active license in the State of Ohio)

Experience:       1+ year paid experience in home and community based service (HCBS), specifically experience with any of the following: incident investigation, assuring individual health and welfare, quality assurance, clinical risk management, the mental health system, or interfacing with law enforcement, nursing homes, children services, adult protective services, or the Department of Developmental Disabilities

Certification: RN, LSW, LISW, LPC, LPCC

Working Conditions:

Office Setting, may work in central office or home office. 


*Employees must follow established work schedules. The usual work schedule is 40 hours per week, Monday through Friday. Normal work hours are 8:00 a.m. to 4:30 p.m. unless otherwise specified by the supervisor, this includes a half hour unpaid lunch break. Total work hours must equal 40 hours per week.


All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, gender identity, marital status, age, national origin, protected veteran status, or disability. Staffing Solutions Organization LLC is an e-Verify participant.

EEO Statement

Public Consulting Group is an Equal Opportunity Employer dedicated to celebrating diversity and intentionally creating a culture of inclusion. We believe that we work best when our employees feel empowered and accepted, and that starts by honoring each of our unique life experiences. At PCG, all aspects of employment regarding recruitment, hiring, training, promotion, compensation, benefits, transfers, layoffs, return from layoff, company-sponsored training, education, and social and recreational programs are based on merit, business needs, job requirements, and individual qualifications. We do not discriminate on the basis of race, color, religion or belief, national, social, or ethnic origin, sex, gender identity and/or expression, age, physical, mental, or sensory disability, sexual orientation, marital, civil union, or domestic partnership status, past or present military service, citizenship status, family medical history or genetic information, family or parental status, or any other status protected under federal, state, or local law. PCG will not tolerate discrimination or harassment based on any of these characteristics. PCG believes in health, equality, and prosperity for everyone so we can succeed in changing the ways the public sector, including health, education, technology and human services industries, work.


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