Nurse Case Manager (Medical Review Nurse - Multiple Openings)

State of Ohio • Columbus, OH

5d • Onsite

About The Position

The Ohio Department of Health’s Bureau of Maternal, Child, and Family Health, Complex Medical Help (CMH) program is hiring four Nurse Case Managers. CMH supports children and youth with complex health care needs and their families. The role combines clinical decision-making, case management, community engagement, and administrative support. Positions are headquartered in downtown Columbus, with vacancies in Columbus and Toledo, Ohio. Travel may be required.

The nurse independently reviews medical applications and determines eligibility for CMH services. The role evaluates diagnoses and medical information, authorizes or denies services under program guidelines, interprets treatment plans, develops care strategies, and monitors ongoing service needs and effectiveness. It also coordinates complex treatment plans with other government programs and manages service authorizations and case data.

The position involves communicating with families, providers, and community partners by phone, in writing, and through site visits across Ohio. The nurse provides technical assistance and orientation on CMH policies, procedures, and billing; participates in educational events and nursing care conferences; resolves service-delivery issues; and collaborates with other case managers and stakeholders. The nurse maintains confidential client records, prepares field reports, assists with program policy and form updates, performs office and administrative tasks, and serves as a liaison to government agencies and partner organizations.

The position is permanent, full-time, hourly, and normally scheduled Monday through Friday, 8:00 a.m. to 5:00 p.m. The stated starting rate is $36.01 per hour, with an opportunity to increase to $37.75 per hour after six months of satisfactory performance and yearly raises thereafter. A criminal background check and pre-employment urinalysis are required for the selected candidate. Official transcripts for post-secondary education claimed on the application must be provided when requested.

Requirements

• Current and valid Ohio Registered Nurse license issued by the Ohio Board of Nursing.
• Meet one of the stated experience pathways: Option 1 requires 24 months of Registered Nurse experience, including at least 12 months in pediatric and/or adolescent nursing or chronic disease management involving care and/or case management of people with complex or special health care needs; Option 2 requires 24 months of Registered Nurse experience, including at least 12 months in prior authorization, durable medical equipment, dental/orthodontic, and/or pharmaceutical reviews; or Option 3 requires 18 months of experience as a Public Health Nurse Specialist (class 65541).
• For Option 1 or Option 2, one course or three months of experience in community health nursing, public health nursing, or research methodologies.
• Equivalent experience may substitute for the experience requirements, but not for the required nursing licensure.
• Applications must clearly document how the applicant meets the minimum qualifications; supplemental-question answers must be supported by work experience or education listed on the civil service application.
• The selected candidate must complete a criminal background check and pre-employment urinalysis.
• Official transcripts for claimed post-secondary education must be provided within five working days of request before a formal offer.

Nice To Haves

• 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, Discharge Planner, or Certified Pediatric Nurse credential.
• Experience providing education and training to local health departments 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 by telephone.
• Experience as a pediatric nurse in a hospital or clinic.
• Experience working in public health.
• Coursework in pediatric complex medical conditions and/or developmental disabilities.

Responsibilities

• Independently assess medical applications and determine eligibility for CMH services.
• Authorize or deny diagnostic, treatment, and service coordination requests based on medical data and program guidelines.
• Interpret medical treatment plans and develop appropriate care strategies.
• Monitor ongoing service needs and effectiveness in compliance with HIPAA and CMH policies.
• Coordinate complex treatment plans 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 regarding 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 support timely and effective case processing.
• 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, including answering phones, managing documents, and operating office equipment.
• Serve as a liaison to government agencies, private-sector partners, and other state programs.

Benefits

• Medical coverage.
• Dental, vision, and basic life insurance premiums at no cost after completion of the eligibility period.
• Paid vacation, personal, and sick leave, plus 11 paid holidays per year.
• Childbirth, adoption, and foster care leave.
• Education and development opportunities, including employee development funds and Public Service Loan Forgiveness.
• Public retirement systems, including OPERS, STRS, SERS, and HPRS.
• Optional deferred compensation through Ohio Deferred Compensation.

What This Job Offers

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