Nurse Case Manager - Internal (Medical Review Nurse - PN 20014026)

Nurse Case Manager- Internal (Medical Review Nurse)

About Us:

Our mission at the Ohio Department of Health (ODH) is advancing the health and well-being of all Ohioans. Our agency is committed to building a modern, vibrant public health system that creates the conditions where all Ohioans flourish.

The Bureau of Maternal, Child, and Family Health (BMCFH)/ Complex Medical Help (CMH) is organized to support families by improving birth outcomes and the health status of women, infants, children, and youth, including children and youth with complex health care needs. Using data and proven practice, the bureau’s programs support the delivery of direct services, linkages and referrals, population-based supports, program evaluation, education, monitoring and quality oversight, and policy and systems development.
 

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What You'll Do:

Are you a compassionate and detail-oriented nurse looking to make meaningful impact in the lives of children with special care needs? This role offers a dynamic blend of clinical decision-making, case management, community engagement, and administrative support—ideal for nurses who thrive in both independent and collaborative environments. Duties Include: 

Clinical and Case Management: 

• Independently assess medical applications and determine eligibility for CMH services. 
• Authorize or deny diagnostic, treatment, and service coordination based on medical data and program guidelines. 
• Interpret medical plans for treatment and develop appropriate care strategies. 
• Monitor ongoing service needs and effectiveness, ensuring compliance with HIPAA and CMH policies. 
• Coordinate complex treatment plants with other state and federal programs. 
• Evaluate diagnoses and determine appropriate services, including medical equipment, orthotics, prosthetics, and orthodontia. 
• Manage case data and service authorizations.

Community Engagement & Education: 

• Maintain contact with families, providers, and community partners through phone, written communication and site visits across Ohio. 
• Provide technical assistance and orientation to providers on CMH policies, procedures and billing. 
• Plan and participate in educational workshops, seminars, and nursing care conferences. 
• Resolve service delivery issues and respond to sensitive inquiries professionally and confidentially. 
• Collaborate with nurse case managers and other stakeholders to ensure timely and effective case processing

Administrative and Liaison Support: 

• Maintain accurate and confidential client records in accordance with national, state and CMH guidelines.
• Perform administrative tasks such as answering phone, managing documents and operating office equipment.
• Serve as a liaison to government agencies, private sector partners and other state programs

UNUSUAL WORKING CONDITIONS: May require travel

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At the State of Ohio, we take care of the team that cares for Ohioans. We provide a variety of quality, competitive benefits to eligible full-time and part-time employees*. For a list of all the State of Ohio Benefits, visit our Total Rewards website! Our benefits package includes:

• Medical Coverage
• Free Dental, Vision and Basic Life Insurance premiums after completion of eligibility period
• Paid time off, including vacation, personal, sick leave and 11 paid holidays per year
• Childbirth, Adoption, and Foster Care leave
• Education and Development Opportunities (Employee Development Funds, Public Service Loan Forgiveness, and more)
• Public Retirement Systems (such as OPERS, STRS, SERS, and HPRS) & Optional Deferred Compensation (Ohio Deferred Compensation)

*Benefits eligibility is dependent on a number of factors. The Agency Contact listed above will be able to provide specific benefits information for this position.

Qualifications

Position Qualifications: 

• Current and valid license to practice professional nursing as Registered Nurse (i.e., R.N.) in Ohio as issued by Board of Nursing pursuant to Section 4723.03 of Revised Code and all of the following bulleted criteria:  

  • 24 mos. exp. in pediatric nursing, which included care of children with special health care needs (i.e., CSHCN) &/or case management of children with multiple health care needs 

  • completion of undergraduate core program in nursing to include 1 course in community health nursing or public health nursing & 1 course in research methodologies or equivalent.

  • 1 course or 3 mos. exp. in operation of personal computer. 

Or 

• Current and valid license to practice professional nursing as Registered Nurse (i.e., R.N.) in Ohio as issued by Board of Nursing pursuant to Section 4723.03 of Revised Code and all of the following bulleted criteria: 

  • 24 mos. exp. in pediatric nursing, which included care of children with special health care needs (i.e., CSHCN) &/or case management of children with multiple health care needs. 

  • 24 mos. exp. in nursing, which included 3 mos. trg. or 3 mos. exp, in community health or public health nursing & 3 mos. trg. or 3 mos. exp. in data collection & analysis.

  • 1 course or 3 mos. exp. in operation of personal computer. 

Or 

Equivalent of Minimum Class Qualifications for Employment noted above may be substituted for the experience required, but not for the mandated licensure. 

Additional Qualifications: 

Applications of those who meet the minimum qualifications will be further evaluated against the following criteria:

• Graduate or advanced degree in nursing

• Experience in pediatric nursing and case management of children/ young adults with special health care needs

• Experience providing technical assistance/consultation services to a local health department or other provider of child /young adults health services (e.g., hospitals, pediatric clinics, physician's offices, other health care related professionals)

• Experience in public/community and/or home health nursing

• Experience reviewing and authorizing medical plans of treatment/requests for services (e.g., may include durable medical equipment/orthotics/prosthetics/orthodontic services/therapies)

• Certified Nurse Case Manager/ Discharge Planner or Certified Pediatric Nurse

• Experience in analyzing health related data to prepare reports (e.g., quality assurance/technical reports, medical reports)

• Experience providing education or training to various groups (e.g., medical groups, nursing staff, parents, young adults)

• Experience with computer software (e.g., Microsoft Office: Word, PowerPoint)

All eligible applications shall be reviewed considering the following criteria: qualifications, experience, education, active disciplinary record, and work record

Job Skills: Nursing

Technical Skills: Health Administration, Medical Records, Nursing, Public Health, Public Relations

Professional Skills: Analyzations, Attention to Detail, Collaboration, Consultation, Verbal Communication, Written Communications

Educational Transcript Requirements: 
Official educational transcripts are required for all post-high school educational accomplishments, coursework or degrees claimed on the application. Applicants will be required to submit an official transcript prior to receiving a formal offer of employment. Failure to provide transcripts within five (5) working days of being requested will cause the applicant to be eliminated from further consideration. 

Please note that a transcript is considered "official" only if it is an original copy from the educational institution and includes an institutional watermark, ink stamp or embossed stamp. Transcripts printed from the institution's website will not be accepted. ODH reserves the right to assess the academic credibility of an educational entity's award of a putative degree.

Supplemental Information:

ALL ANSWERS TO THE SUPPLEMENTAL QUESTIONS MUST BE SUPPORTED BY THE WORK EXPERIENCE/EDUCATION PROVIDED ON YOUR CIVIL SERVICE APPLICATION.
Unless required by legislation, the selected candidate will begin at Pay Grade 13, Step 1 of the SEIU/1199 union Pay Range Schedule ($34.96 per hour), with an opportunity for pay increase after six months ($36.65 per hour) of satisfactory performance and then a yearly raise thereafter. 

APPLICATION PROCEDURES: 
All applicants must submit a completed Ohio Civil Service Application using the TALEO System. Paper applications will not be considered. Applicants must clearly indicate how they meet the minimum qualifications and/or position specific minimum qualifications. Applicants are also encouraged to document any experience, education and/or training related to the job duties above. An assessment of these criteria may be conducted to determine the applicants who are interviewed.

STATUS OF POSTED POSITION:
You can check the status of your application online by signing into your profile. Jobs you applied for will be listed. The application status is shown to the right of the position title and application submission details.

BACKGROUND CHECK NOTICE:
The final candidate selected for this position will be required to undergo a criminal background check. Criminal convictions do not necessarily preclude an applicant from consideration for a position. An individual assessment of an applicant's prior criminal convictions will be made before excluding an applicant from consideration.

All final applicants tentatively selected for this class will be required to submit to urinalysis to test for illegal drug use prior to appointments. An applicant with a positive test shall not be offered employment.

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Ohio is a Disability Inclusion State and strives to be a model employer of individuals with disabilities. The State of Ohio is committed to providing access and inclusion and reasonable accommodation in its services, activities, programs and employment opportunities in accordance with the Americans with Disabilities Act (ADA) and other applicable laws.

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The State of Ohio is a drug-free workplace which prohibits the use of marijuana (recreational marijuana/non-medical cannabis). Please note, this position may be subject to additional restrictions pursuant to the State of Ohio Drug-Free Workplace Policy (HR-39), and as outlined in the posting.