HCBS Incident Investigator

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility.
 

Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT

Position Purpose:
This role will be responsible for the development, implementation, investigation, monitoring and oversight of incident reporting at the member and organizational level. The primary functions will include incident reporting identification, investigation, inter-departmental coordination, and external partnership collaboration. This position ensures Buckeye's compliance with our contractual and regulatory requirements, including but not limited to, Centers for Medicare Services (CMS), the Ohio Department of Medicaid (ODM) and the Ohio Administrative Code (OAC).

• Development, coordination, and maintenance of initial and ongoing education as it pertains to Incident Reporting in accordance with regulatory requirements.
• Identification, investigation and processing of incidents, as applicable, and in alignment with state/federal regulations (Abuse, neglect, misappropriation, exploitation, health, and welfare, among others)
• Collaboration of Incident Management with state contracted investigation organization.
• Investigation of incidents that do not fall to the stated contracted investigation organization.
• Oversight of prevention plan determination and resolution.
• Audit Incidents to assure compliance and alignment for annual state/federal audit.
• Collects and reviews clinical documentation and makes a determination of substantiation/substantiation based on investigation.
• Performs other duties as assigned.
• Complies with all policies and standards.

Education/Experience: A degree in Nursing, Social Work, and/or Counseling. Five years of experience required. Must have knowledge of LTSS, Waiver and Incident Reporting. Preferred qualifications are bachelor’s in nursing and master’s in social work and/or Counseling.
Licensure or Certifications: RN, LSW, LISW, LPC or LPCC required.

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules.  Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status.  Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act