Incident Management Investigator (Dayton)

Job Summary :

The Incident Management Investigator conducts clinical case investigations related to incidents submitted to the incident management system.

Essential Functions :

• Investigation includes interviewing member, claimant (if claimant is not the member), personal caregivers, facility staff and others
• Contacts providers & their employees, business partners and representatives from regulatory agencies and law enforcement in the conduction of investigations,
• Develops member care plan including member and caregiver education and corrective action plans
• Collaborates with internal departments including, but not limited to, Care Management, SIU, Pharmacy, Medical Management, Provider Relations, Claims, Internal Audit, Regulatory, andLegal
• Develops and maintains contacts / liaison with business partners, law enforcement, regulatory agencies, state, other company staff and external contacts involved in fraud investigation, detection and prevention
• Proactively uses analytical skills to identify all potential areas of member concern including fraud, waste and abuse
• Responsible for assisting department in meeting all state, regulatory and departmental deadlines
• Recommends and participates in development and implementation of internal departmental policies and procedures
• Perform any other job related instructions, as requested

Education and Experience :

Competencies, Knowledge and Skills :

Licensure and Certification :

Working Conditions :

Compensation Range :

$61,500.00 - $98,400.00 CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type : Salary

Competencies :

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.

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