Medical Investigator

Medical Investigator

Job Description

DUTIES AND RESPONSIBILITIES:

Conducting investigations for allopathic physicians and physician assistants licensed in AZ related to quality-of-care allegations and unprofessional conduct. Matters investigated include quality of care allegations, criminal convictions, and sensitive issues such as substance abuse and sexual misconduct.

Duties are equivalent of a paralegal or high-volume case manager. Duties include reviewing the complaint and preparing notice letters to respondent with allegations and reaching out to the complainant; determine appropriate medical records or supporting documents to request by subpoenas; conduct interviews of the respondent, complainant, patient and/or any witnesses; interpret statutes and rules; manage multiple cases at varying stages in the investigative process; prepare case reports and present cases before the Medical Board; on occasion, testify before the Office of Administrative Hearings; prioritize, plan, organize, and conduct investigations, including site inspections.

Day to Day Tasks Include:
Review complaints, determine allegations, draft notice letters to respondent and contact the complainant
Request medical records or supporting documents/information relevant to the investigation
Follow-up on outstanding requests/responses
Organize (bookmark) medical records/supporting documents to add to the case file
Determine next steps within the investigation to keep the case moving forward
Provide status updates when requested to complainant and respondent
Prepare memos/investigative reports for matters related to unprofessional conduct
Conduct interviews with complainants, respondents or witnesses
Prioritize daily tasks
Update case notes and case status
Respond to inquiries from the Medical Consultants reviewing cases

SKILLS:
Experience in reading and interpreting medical records.
Skill in production of timely and accurate reports and documentation.
Skills in applying and interpreting the client statutes and rules governing investigations and the practice of medicine.
Skill in presenting cases in a hearing or trial setting. Must be able to handle and prioritize a large case load.
Medical Assistant / healthcare background, paralegal training, medical billing, and coding experience is a plus.

Top 3 Required Skills: (Non-Negotiable)
1. Effective written and oral communication (including email)
2. Organization and Follow Through
3. Knowledge of Microsoft Office Suites (Word, Adobe PDF)

Top 5 Preferred Skills: (Preferences)
1. Self-Starter: Enthusiasm, Flexibility and Motivation; Work effectively without regularly needing to be told what to do
2. Critical Thinking and Problem-Solving: Identify similar situations following established routines/instructions
3. Team Player: Ability to work with various investigators, internal and external medical physicians, support staff services, and different departments
4. Knowledge of healthcare terminology
5. Medical Assistant / Background in Healthcare

ABILITIES:
Ability to conduct investigations, including review of medical records to determine relevance to the investigation.
Ability to multi-task, prioritize, plan, analyze, and coordinate investigations.
Ability to extract and utilize facts from a variety of sources and apply the relevant statutes, rules and policies to prepare clear, accurate and quality documents within specified time frames.

Notes:
Position will be in office until they are finished with training and are able to work independently
Hybrid schedule after training will be 3 days at home 2 days in office

VIVA is an equal opportunity employer. All qualified applicants have an equal opportunity for placement, and all employees have an equal opportunity to develop on the job. This means that VIVA will not discriminate against any employee or qualified applicant on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.