Nurse Case Manager (Medical Review Nurse - Multiple Openings)

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.

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: Requires travel within assigned counties in the State of Ohio. 

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.

ALL ANSWERS TO THE SUPPLEMENTAL QUESTIONS MUST BE SUPPORTED BY THE WORK EXPERIENCE/EDUCATION PROVIDED ON YOUR CIVIL SERVICE APPLICATION.

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.

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.

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.

• 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

• 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.

• 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

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

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