Nurse Case Manager - Internal; Medical Review Nurse - PN

Job Description - Nurse Case Manager - Internal (Medical Review Nurse - PN ) (250009CG)

Nurse Case Manager - Internal (Medical Review Nurse - PN ) ( 250009CG )

Health

Agency Contact Name and Information:
Gayla. A will contact you if selected for interview.

Ongoing

Health Department Building 246 North High Street 1st Floor Columbus 43215

United States of America-OHIO-Franklin County-Columbus

Compensation: $34.96

Full-time

Work Hours:

Monday - Friday; 8am - 5pm

Union: 1199

Nursing

Technical

Skills:

Health Administration, Nursing, Public Health, Public Relations, Medical records

Professional

Skills:

Analyzation, Attention to Detail, Collaboration, Consultation, Verbal Communication, Written Communication

Nurse Case Manager
- Internal (Medical Review Nurse)

About Us:

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.

What You’ll Do:

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.

Duties Include:

• 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.

May require travel

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…