Hospital Investigator

The Hospital Investigator position serves as an internal investigator for the Arizona State Hospital (ASH). This position conducts complex, high-visibility, and legally sensitive investigations related to allegations of patient right violations or compliance concerns. The Hospital Investigator handles complaint investigations in accordance with regulatory requirements from the Arizona Department of Health Services (ADHS) Medical Facilities Licensing, Joint Commission and the Centers for Medicare and Medicaid Services (CMS).

This position also investigates allegations of rights violations related to behavioral health services for patients determined to have a serious mental illness (SMI), in accordance with Arizona Administrative Code (A.A.C.) Title 9, Chapter 21. The Hospital Investigator prepares a written report of their findings at the conclusion of their investigation for presentation to the Complaint, Grievance and Appeal Committee, keeping in accordance with time frames established in the AAC Title 9 Chapter 21 and Hospital policy.

This position will also assist in the mediation of SMI appeals associated with a patients behavioral health services in accordance with AAC Title 9 Chapter 21. As applicable, this position may testify at administrative hearings as an official witness. The Hospital Investigator may perform compliance reviews as related to regulatory issues according to local, state and federal regulations. This position will perform audits based upon the findings from the complaints, SMI grievances or compliance reviews.

This position works closely with the Hospital Patient Right Advocate, Hospital direct care staff, Hospital Leadership, ADOA Ombudsman, patients, patient guardians, contractors, and when applicable, outside agencies. This position will also assist with complaint investigations and/or surveys by the ADHS Medical Division of Licensing, Centers for Medicare and Medicaid Services, and the Joint Commission.

• Serve as a subject matter expert in dispute resolution, clinical communication, and risk mitigation, conducting objective, thorough end-to-end investigations while safeguarding patient rights and organizational integrity. Conducts interviews of witnesses, staff, patients, and other relevant individuals; reviews and processes data, documents, and medical records; drafts investigation reports, decision letters, appendixes, and maintains case file; maintains strict compliance with CMS regulations, Joint Commission standards, and state health department guidelines regarding grievance response timelines.
• Perform complex internal audits to identify systemic operational vulnerabilities, clinical trends, and recurrent risk areas in accordance with regulatory requirements of the ADHS Medical Facilities Licensing, Joint Commission and CMS. Audits will include partnering Medical, Nursing and Clinical Leadership as Compliance, Quality, Legal and Health Records Departments to gather evidence, interview staff/patients, review of prior deficiencies, tracer activities, Hospital policy review, and patient chart reviews.
  
  Detailed audit report will be drafted with presentation of actionable findings in both written and oral format.
• Schedules and Mediates SMI appeal informal conferences while seeking resolution that would be acceptable by the patient. Completes a detailed report of the conference outlining the resolved and non-resolved issues.
• Provide witness testimony at administrative fair hearings before the Office of Administrative Hearings. Review the investigation report and supporting evidence and discuss the findings (interviews, records/documentation, surveillance, etc.) with legal counsel to prepare for testimony and cross examination.
• Other duties as assigned as related to the position (typically 5% - 10%)

Knowledge of civil and administrative law, federal Medicaid/Medicare statutes, rules and regulations as they relate to Title 19, United States Code and additional knowledge of Arizona Revised Statutes, Title 36 and Title 13.
Knowledge of patients rights, along with Grievance and appeal procedures for Persons with Serious Mental Illness under Arizona Administrative Code Title 9, Chapter 21.
Knowledge of medical terminology and procedures to review specific medical records.
Knowledge of proper methods of…