Nurse Case Manager (Medical Review Nurse - Multiple Openings)

Who We Are 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. 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 r equire 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 13 on the Ohio Health Care SEIU/1199 Pay 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. Application Procedures: We only accept applications submitted online through this portal (careers.ohio.gov). To be evaluated for the role, your application must clearly indicate how you meet the minimum qualifications and/or position specific minimum qualifications. We cannot give credit for experience, education, or training unless it is explicitly stated in the application. An assessment of these criteria may be conducted to determine the applicants who are interviewed. ALL ANSWERS TO THE SUPPLEMENTAL QUESTIONS MUST BE SUPPORTED BY THE WORK EXPERIENCE/EDUCATION PROVIDED ON YOUR CIVIL SERVICE APPLICATION. Status of Posted Position: You may check the status of your application by signing in to your profile on this website (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.