Job Overview
Location
Remote
Job Type
Full-time
Category
Human Resources
Date Posted
May 27, 2026
Full Job Description
📋 Description
- • The Incident Management Investigator conducts clinical case investigations related to incidents submitted to the incident management system, playing a critical role in identifying and addressing potential fraud, waste, and abuse in healthcare operations.
- • Day-to-day responsibilities include interviewing members, claimants, caregivers, facility staff, and providers; collaborating with internal departments such as Care Management, SIU, Pharmacy, Medical Management, and Legal; developing member care plans and corrective action plans; and maintaining liaisons with law enforcement, regulatory agencies, and business partners.
- • The role is part of CareSource Management Group Company, a healthcare organization dedicated to improving member health and well-being through innovative care delivery and strong community partnerships.
- • In this role, the investigator will develop advanced analytical and investigative skills, gain deep expertise in healthcare compliance and Medicaid/Medicare systems, and contribute to policy development while ensuring timely resolution of cases in alignment with regulatory and departmental standards.
🎯 Requirements
- • Associate's degree required (or equivalent relevant work experience)
- • Two (2) years of experience in healthcare operations, care coordination, escalation, or management
- • Intermediate proficiency with Microsoft Outlook, Word, Excel, PowerPoint, and Access
- • Effective oral and written communication skills
- • Ability to conduct thorough investigations, develop care plans, maintain confidentiality, and meet deadlines
- • Knowledge of medical terminology and instances of fraud, waste, and abuse (FWA) preferred
🏖️ Benefits
- • Salary range of $62,700.00 - $100,400.00
- • Potential for performance-based bonus tied to company and individual performance
- • Comprehensive total rewards package focused on employee well-being
- • Opportunity to work remotely
- • General office environment with no typical travel required
- • Access to professional development through organizational level competencies (e.g., fostering collaboration, driving execution, pursuing personal excellence)
Skills & Technologies
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About CareSource Management Group Company
CareSource is a nonprofit, multi-state managed care organization headquartered in Dayton, Ohio. Founded in 1989, it administers Medicaid, Medicare Advantage, and Marketplace health plans serving over two million members in Ohio, Kentucky, Indiana, West Virginia, and Georgia. The company focuses on improving health outcomes for low-income and vulnerable populations through integrated care management, behavioral health services, and social determinants programs.
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