Nurse Case Manager (Medical Review Nurse - Multiple Openings)

All job postings will expire at 11:59 PM Eastern Time on the application deadline. Organization: Health Work Location: 246 North High Street, 1st Floor, Columbus, Ohio, 43215, United States Compensation: $36.01 Schedule: Permanent - Full Time Work Hours: Mon - Fri; 8:00am - 5:00pm Classified Indicator: Classified Union: 1199 Primary Job Skill: Nursing Who We Are Our mission at the Ohio Department of Health (ODH) isadvancing the health and well-being of all Ohioans. Our agency iscommitted to building a modern, vibrant public health system that creates theconditions 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. Location Requirements: Positions are headquartered in downtown Columbus, Ohio (Franklin County). Vacancies are available in both Columbus and Toledo (Lucas County, OH) offices. What You'll Do Are you a compassionate, detail-oriented nurse looking to make meaningful difference in the lives of children with special health care needs? The Complex Medical Help (CMH) program is seeking to fill FOUR vacancies. These positions offer 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. Prepare field reports and assist with updates to CMH policies, procedures, standards, and forms. 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. Additional Information Normal working hours are Monday through Friday, 8:00am to 5:00pm. This is an hourly position, with a pay range of 13on the Ohio Health Care SEIU/1199Pay Range Schedule. Unless required by legislation, the selected candidate will begin at Pay Grade 13, Step 1 of the SEIU/1199 Pay Range Schedule ($36.01 per hour), with an opportunity for pay increase after six months ($37.75 per hour) of satisfactory performance and then a yearly raise thereafter. Status of Posted Position You may check the status of your application by signing in to your profile on thiswebsite (careers.ohio.gov). We will communicate with you through the email you provided in your profile and job application. 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. Educational Transcript Requirements Official educational transcripts are required for all post-secondary education claimed on the application before a formal job offer can be made. Transcripts must be provided within five (5) working days of the request; failure to provide them will cause elimination from further consideration. Transcripts must be originals sent directly from the institution featuring an institutional watermark, ink stamp, or embossed stamp. Web printouts will not be accepted. ODH reserves the right to evaluate the credibility of any degree or educational institution. Why Work for the State of Ohio 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 Option 1 Current & 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 24 mos. exp. as a Registered Nurse which includes at least 12 mos. exp. as a Registered Nurse in pediatric &/or adolescent nursing, &/or chronic disease management, to include care &/or case management of children, adolescents, or adults with complex &/or special health care needs 1 course or 3 months exp in community health nursing, public health nursing, or research methodologies. OR Option 2 Current & 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 24 mos. exp. as a Registered Nurse which includes at least 12 mos. exp. as a Registered Nurse in prior authorization reviews, durable medical equipment reviews, dental/orthodontic reviews, &/or pharmaceutical reviews 1 course or 3 months exp in community health nursing, public health nursing, or research methodologies. OR Option 3 Current & 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 18 mos. exp. as a Public Health Nurse Specialist, 65541. OR Equivalent of Minimum Class Qualifications for Employment noted above may be substituted for the experience required, but not for the mandated licensure. Applications of those who meet the minimum qualifications will be further evaluated against the following criteria: Graduate or advanced degree in nursing Experience in case management of children and/or young adults with multiple health care needs Certified Nurse Case Manager or Discharge Planner or Certified Pediatric Nurse Experience providing education and training to local health department or medical providers Experience working with children and/or young adults with special healthcare needs Experience interpreting and following medical policies and procedures Experience providing customer service and education via telephone Experience working as a pediatric nurse in a hospital or clinic Experience working in public health Coursework in pediatric complex medical conditions and/or developmental disabilities 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 ADA Statement 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. Drug‑Free Workplace 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. #J-18808-Ljbffr State of Ohio