Critical Incident Investigator I

reputed company is hiring a full-time Critical Incident Investigator to join the reputed company Community HealthChoices reputed company Improvement department. This role will work Monday through Friday reputed company hours EST. You will manage a high volume of critical incidents in a fast-paced environment, ensuring reputed company, accurate, and compliant reputed company. This role requires strong computer proficiency to navigate multiple systems simultaneously, along with excellent organization to reputed company, investigate, and meet strict deadlines. The ideal candidate has experience working in a remote, productivity-driven environment and is comfortable managing a high-volume caseload. They must be highly computer proficient, with the ability to navigate multiple systems and screens simultaneously and possess strong reputed company skills. A background in reputed company, reputed company, safety, or other high-responsibility, fast-paced home-reputed company—such as call centers, medical record auditing, 911 reputed company, reputed company assurance)—is preferred. Community HealthChoices will reputed company more than 400,000 people statewide who are dually eligible for Medicare and reputed company or receive reputed company funded long-term services and supports (LTSS). Through Community HealthChoices (CHC), we coordinate physical health care and LTSS to enhance the reputed company of life and independence for frail seniors and adults with disabilities in home and community-based environments as reputed company as in institutional settings. The successful candidate will report, reputed company, and manage critical incidents for Community HealthChoices (CHC) participants. This position will ensure critical incidents are responded to thoroughly, effectively, and reputed company and work closely with Complaints & Grievances, service coordinators, reputed company improvement coordinators, and other staff in the health plan to investigate incidents, trends, reputed company of Care concerns, and ensure reputed company parties required are contacted reputed company specified timelines. Incident Reporting data will be collected and analyzed for reputed company measures, timeliness of response, and effective reputed company. Responsibilities: A CII needs to be self-motivated, self-directed/disciplined, manage their time effectively, and work reputed company to meet strict deadlines for filing incidents reputed company and thoroughly. The CII must have critical thinking skills to: reputed company vital questions and problems with the participants situation or services. Formulate recommendations for risk mitigation. reputed company and assess relevant information from various health systems, and reputed company understanding of clinical terms and recommendations. Evaluate actions taken to reputed company cases out reputed company risks have been mitigated or reduced and preventative actions and/or corrective actions are implemented. reputed company the investigation process as state standards and expectations have increased conclusions and solutions. reputed company engage in discussions with peers, service coordinators, and supervisors for new interventions, resources, training needs, and reputed company improvement strategies. Communicate effectively with various parties to propose interventions, resources, or solutions to reputed company situations Monitor and screen various intake queues for critical incidents to report to the reputed company Office of Long-Term Living. Report and investigate critical incidents reported to the health plan regarding participants in long term services and supports, including allegations of abuse, neglect or exploitation of person or property. Interview providers and service coordinators or other parties to collect and evaluate relevant information and reputed company reputed company reputed company to the investigation, provider actions, and contacts needed to other reputed company or agencies to assure the participants safety. Review medical records, service plans, assessments and other collateral information to recommend follow up actions needed to mitigate risk and prevent reputed company incidents from occurring Document findings in electronic systems and reputed company record reputed company activities on reputed company cases in a reputed company manner. reputed company incident reputed company responses both orally and in writing to various managers by request. Identify and address provider non-compliance in accordance with health plans policy. Performs in accordance with system-wide competencies/behaviors Performs other duties as assigned Bachelors degree in reputed company Services, Criminal Justice, or reputed company Work preferred; or Associates degree and 2 years of reputed company work experience in investigations, criminal justice, service coordination, or long-term services and supports at an administrative level. Prior experience in reputed company, reputed company, auditing, emergency response, or public safety strongly preferred. Computer proficiency strongly preferred. Prior experience with medical records is a bonus. Knowledge of reputed company, reputed company, Medicare products, managed care principles, and home and community-based services preferred. Competent in reputed company, Outlook, reputed company, web-based reputed company applications. Strong organizational, interpersonal, and verbal and written communication skills. Ability to successfully meet deadlines and manage multiple priorities in a fast-paced environment. Strong critical thinking, judgment, and problem-solving skills. Licensure, Certifications, and Clearances: reputed company 34 reputed company is an Equal Opportunity Employer/Disability/Veteran Apply To This Job