Job Description

Job Description:

Job Title: HCBS Incident Investigator
Location: Remote Ohio (Must have Ohio License & MyCare Waiver Knowledge)
Duration: 6 Months Contract (High possibility of Extension/Conversion)
Schedule: Monday Friday | 8:00 AM 5:00 PM EST
Overtime: Not required (Only if needed)
Pay Range: $38.00 - $42.00 Per hr on w2.

Position Overview

The Incident Investigator is responsible for the development, implementation, investigation, and oversight of waiver-related incident reporting at both member and organizational levels. This role ensures compliance with the Three-Way Contract, Provider Agreements, Ohio Administrative Code, CMS regulations, and MyCare Ohio Waiver requirements.

The position plays a critical role in safeguarding member health, safety, and welfare by ensuring timely reporting, investigation, and resolution of critical incidents.

Team & Business Overview

The team supports Medicaid and MyCare Ohio members by identifying and managing critical incidents and ensuring submission into the Ohio Department of Medicaid Incident Management System (IMS).

• Increased workload has driven the need for this position
• Highly collaborative, accountable, and service-driven team culture
• Strong coordination with internal teams and external stakeholders
• Focus on prevention planning and improving member outcomes

Key Responsibilities

Incident Investigation & Management

• Review and validate incidents to determine if they meet critical incident criteria
• Submit incidents into the Ohio Incident Management System (IMS) within required timelines
• Conduct thorough investigations using claims, clinical data, case management notes, and assessments
• Collaborate with care coordination teams, CMEs, and law enforcement (if applicable)
• Substantiate or un-substantiate incidents based on findings

Case Oversight & Compliance

• Ensure all cases are reviewed and completed within 45 days
• Develop and implement prevention plans within 7 business days
• Maintain accurate and compliant documentation throughout the lifecycle
• Ensure adherence to:
  • Ohio Administrative Code
  • CMS regulations
  • MyCare Ohio Waiver (1915c)
  • Provider contracts and MCO requirements

Collaboration & Communication

• Work closely with internal teams, providers, and external partners
• Occasionally interact with members via phone, email, or fax
• Support a team-oriented, collaborative work environment

Systems & Tools

• Trucare
• Ohio Incident Management System (IMS)
• Impact Pro
• Microsoft Office Suite (Excel, Outlook, Teams, Word)

Qualifications

Required

• Bachelor's degree in:
  • Nursing, Social Work, Counseling, or related field
• Active Ohio License (one of the following):
  • RN, LSW, LISW, LPC, or LPCC
• 5+ years of clinical experience in field of licensure
• Strong knowledge of:
  • Ohio MyCare Waiver
  • Medicaid programs
  • Incident reporting processes
• Strong critical thinking and independent working ability
• Tech-savvy with ability to navigate multiple systems

Preferred

• Managed care experience
• Experience with waiver programs and CMS guidelines

Top 3 Required Skills

1. Strong clinical background & critical thinking
2. Proficiency with MS Office (Excel, Teams, Outlook, Word)
3. Ability to multitask and work efficiently across systems

Performance Metrics

• Timely incident submission into IMS
• Case closure within required timelines
• Accuracy and compliance of documentation
• Implementation of prevention plans within deadlines

Training & Onboarding

• 4-week training (Mon Fri, 8 AM 5 PM EST)
• No time off allowed during training
• Mix of classroom and 1:1 training

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