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State of Washington Classified Job Specification

HEALTH CARE INVESTIGATOR 1

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HEALTH CARE INVESTIGATOR 1
428E
Category: Legal Services

Class Series Concept

Positions in this series investigate complaints against Licensed Health Care Providers in a variety of areas including allegations of violations of state licensure laws and/or criminal statutes. Investigations may also involve compliance review to ensure the regulatory standards are followed. These investigations are both civil and criminal in nature and include but are not limited to allegations of Gross Misconduct, Billing Fraud, Sexual Misconduct and Abuse to name a few of the many types of investigations. Investigations of health care complaints include highly political issues, extremely sensitive, complex, multi-jurisdictional cases having statewide or national impact. These cases often result in financial, physical and mental harm that impacts patient safety and public health.

The investigation and research that goes into an investigation includes gathering facts and developing evidence through the use of interviews, site visits and records review. An investigator’s responsibility is to develop a complete case from the original claim or allegation through preparation for presentation in court or administrative hearing. Other case preparation includes obtaining statements of fact, depositions and confessions; obtaining and serving subpoenas to compel the attendance of witnesses or the production of records; conducting field surveillance; coordinating with local law enforcement the service of search warrants; writing investigative reports, establishing proof of facts and evidence; reviewing the case with private attorneys, assistant attorneys general, or prosecuting attorneys; and testifying in court or other proceedings as necessary.

Definition

Performs health care investigations.  Conducts investigations of alleged violations of state licensure laws by health care professionals.

Distinguishing Characteristics

This is an entry level.  Incumbents work under close supervision and within narrowly established guidelines and parameters.  Work tasks are repetitive and routine and decision-making is limited. 

Typical Work

Learn and apply statutes, regulations, policies and procedures, and effective investigation techniques to conduct health care provider investigations;

Investigate allegations against health care professionals that impact public health and safety. Examples of allegations include providing substandard health care, providing health care without licenses or credentials, drug diversions, abuse or neglect, or any other behavior that creates inadequate or inappropriate services;

Formulates and writes an investigative plan with supervisor oversight that identifies possible RCW and WAC violations documented in the complaint, facts that need to be investigated, witnesses to be interviewed, and evidence to be gathered;

Writes and serves subpoenas to compel attendance of witnesses or the production of records;

Conducts interviews of the complainant, witnesses, and respondent(s);

Gathers, preserves, analyzes, and evaluates documentary and physical evidence. This may include audits of health care, business, governmental and financial records;

Reviews cases with attorneys, administrators and program managers; participates in staff meetings and case conferences;

Prepares written reports which record the result of investigations and catalogs, identifies, and conveys all physical evidence and statements of witnesses in a manner adequate to support administrative action, civil actions brought by the Attorney General, and criminal cases brought by county or federal prosecutors or in cooperation with local law enforcement;

May participate in legal proceedings, including testimony in administrative hearings and courts as required.

Knowledge and Abilities

Knowledge of:  statutes regulating practice and licensing of the health care professions; related laws and court decisions, rules of evidence; court procedures; principles, standards and techniques of investigations; practices, procedures and principles of biological, physical and social sciences.

 

Ability to:  understand and interpret laws and court decisions relating to the health care professions; focus issues and assess behavior according to standards of practice in the health care professions; conduct investigations; gather, preserve, and present material relevant and pertinent evidence; write and speak clearly, concisely, accurately and informatively; exercise mature judgment in a wide variety of situations involving contact with the public; and develop investigative skills under supervision.

Legal Requirement(s)

There may be instances where individual positions must have additional licenses or certification. It is the employer’s responsibility to ensure the appropriate licenses/certifications are obtained for each position.

Desirable Qualifications

A Bachelor’s degree and two years’ experience as a licensed Registered Nurse, Dentist, Physician, Dental Hygienist, Veterinarian, Chiropractor, or Certified Physician’s Assistant.  All of the above-mentioned health professions must be eligible for Washington State licensure. 

Note:  A Master’s or Graduate degree in one of the above professions will substitute for one year of the required experience.

OR

A Bachelor’s degree and our years of investigative experience with a criminal investigative entity, or experience investigating fraud and/or deceptive business practice within a regulatory entity, four years of which must include field experience. Additional investigative experience may be substituted for education on a year for year basis.

Note:  A Master's degree in Criminal Justice, Business or Public Administration, or a related field will substitute for two years of investigative experience, excluding field experience.

Class Specification History

New class: 11-13-87
Revised definition, minimum qualifications and add distinguishing characteristics: 9-13-91
Revise minimum qualifications: 11-15-96
New class code: (formerly 46940) effective July 1, 2007
Revised salary range, class concept, definition, typical work, distinguishing characteristics and desirable qualifications; adopted June 30, 2017, effective July 1, 2017

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