Nurse Case Manager - Internal; Medical Review Nurse - PN

What You’ll Do

Are you a compassionate and detail-oriented nurse looking to make a 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 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 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.

• Current and valid license to practice professional nursing as Registered Nurse (R.N.) in Ohio, as issued by the Board of Nursing pursuant to Section 4723.03 of the Revised Code, and all of the following criteria:
  • 24 months experience in pediatric nursing, including care of children with special health care needs (CSHCN) and/or case management of children with multiple health care needs.
  • Completion of an undergraduate core program in nursing that includes at least one course in community health nursing or public health nursing and at least one course in research methodologies.
  • One course or three months of experience in operation of a personal computer.
• Option 2:
  Current and valid license to practice professional nursing as Registered Nurse (R.N.) in Ohio, as issued by the Board of Nursing pursuant to Section 4723.03 of the Revised Code, and all of the following criteria:
  • 24 months experience in pediatric nursing, including care of children with special health care needs (CSHCN) and/or case management of children with multiple health care needs.
  • 24 months experience in nursing, which includes three months of training or three months of experience in community health or public health nursing and three months of training or three months of experience in data collection & analysis.
  • One course or three months of experience in operation of a personal computer.
• Equivalent minimum class qualifications for employment may be substituted for the experience required, but not for the mandated licensure.

• 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 adult health services (e.g., hospitals, pediatric clinics, physicians’ 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 (may include durable medical equipment, orthotics, prosthetics, orthodontic services, therapies).
• Certified Nurse Case Manager…