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

State of Ohio • Columbus, OH

21d

About The Position

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. 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.

Requirements

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

Nice To Haves

• 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)

Responsibilities

• 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.
• 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
• 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

Benefits

• 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 )

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed