Job Opportunities in United States

Nurse Case Manager (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 Ohio Department of Health supports a hybrid teleworking model. This position may work a hybrid schedule at the discretion of the manager or supervisor, which will require occasional attendance in the office for training, meetings and other operational needs. Employees must reside within a reasonable distance to their assigned headquarters for compliance with workplace reporting requirements.
The Bureau of Child and Family Health’s (BCFH) Children with Medical Handicaps program (CMH) links families of children with special health care needs to a network of quality providers and helps families obtain payment for the services their children need. CMH’s mission is to assure that children with special health care needs and their families obtain comprehensive care and services that are family centered, community based, and culturally sensitive.
What You'll Do:
The Nurse Case Manager will be responsible for independently determining eligibility of children with special health care needs applying for or enrolled in the CMH Program. This position will analyze health care data and plans to draw conclusions about service delivery problems and determine the most appropriate plan of care.
The ideal candidate will have experience reviewing health data, researching diagnoses, and assessing medical plans of treatment. Additional duties may include:

• Independently determine program eligibility for children with special health care needs.
• Analyze and interpret health, medical, and nursing data to draw conclusions to determine appropriate plan of care.
• Use independent judgment in the coordination of complex CMH treatment plans with other state and federal programs (e.g., Title XIX, RSC, SSI, Help Me Grow, MRDD, Ryan White, schools).
• Consult with external partners like physicians and local health departments to assure quality care.
• Plan, coordinate, and participate in educational workshops, seminars and nursing care conferences on topics related to care of children with special health care needs.
• Maintain client records in a confidential manner using established national, state and CMH guidelines
• Interpret, explain, carry out and inform local agencies and providers of changes.

What’s in it for you:
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

• Quality, affordable, and competitive medical benefits are offered through the available Ohio Med plans.
• For more information about our plans, visit: State of Ohio Medical Plans or our My Benefits Guide.

Dental, Vision and Basic Life Insurance

• Dental, vision, and basic life insurance premiums are free after completed eligibility period. Length of eligibility period is dependent on union representation.

Time Away from Work and Work/Life Balance

• Paid time off, including vacation, personal, and sick leave.
• 11 paid holidays per year.
• Childbirth/Adoption leave.
• For more information, visit our Total Rewards website!

Employee Development Funds

• The State of Ohio offers a variety of educational and professional development funding that varies based on whether you are a union-exempt employee or a union-represented employee.

Ohio Public Employees Retirement System

• OPERS is the retirement system for State of Ohio employees. The employee contributes 10% of their salary towards their retirement. The employer contributes an amount equal to 14% of the employee’s salary. Visit the OPERS website for more information.

Deferred Compensation

• The Ohio Deferred Compensation program is a 457(b) voluntary retirement savings plan. Visit the Ohio Deferred Compensation website for more information.

Qualifications Current and 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. in pediatric nursing, which included care of children with special health care needs (i.e., CSHCN) &/or case management of children with multiple health care needs; completion of undergraduate core program in nursing to include 1 course in community health nursing or public health nursing & 1 course in research methodologies or equivalent; 1 course or 3 mos. exp. in operation of personal computer.

OR
Current and 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; completion of undergraduate core program in nursing to include 1 course in community health nursing or public health nursing & 1 course in research methodologies or equivalent; 24 mos. exp. in pediatric nursing, which included care of children with special health care needs (i.e., CSHCN) &/or case management of children with multiple health care needs; 1 course or 3 mos. exp. in operation of personal computer.

OR
Equivalent of Minimum Class Qualifications for Employment noted above may be substituted for the experience required, but not for the mandated licensure.
Applications of those who meet the minimum qualifications will be further evaluated against the following criteria:

• Bachelor’s or advanced degree in Nursing
• At least 1 year experience in Pediatric Nursing
• Experience providing technical assistance/consultation services to a health department or other provider of child health services (e.g., hospitals, pediatric clinics, physician office)
• At least 1 year nursing experience working with children with special health care needs
• Experience reviewing and authorizing medical plans of treatment/requests for services (may include durable medical equipment/orthotics and orthodontic services.
• Certified Nurse Case Manager/Discharge Planner/Certified Pediatric Nurse
• Experience analyzing health related data to prepare reports (e.g., quality assurance/technical/medical reports)
• Experience providing education or training to various groups (e.g., medical, nursing staff, parents)
• Experience working with computer software (e.g., Word, Power Point)
• Experience in public/community/home health nursing

Job Skills: Nursing
Technical Skills: Medical Records, Nursing
Professional Skills: Attention to Detail, Decision Making, Reasoning
Supplemental Information Supplemental Information:
ALL ANSWERS TO THE SUPPLEMENTAL QUESTIONS MUST BE SUPPORTED BY THE WORK EXPERIENCE/EDUCATION PROVIDED ON YOUR CIVIL SERVICE APPLICATION.
Unless required by legislation, the selected candidate will begin at Pay Grade 13, Step 1 of the 1199 Pay Range Schedule ($31.86 per hour), with an opportunity for pay increase after six months ($33.40) of satisfactory performance and then a yearly raise thereafter.
APPLICATION PROCEDURES:
All applicants must submit a completed Ohio Civil Service Application using the TALEO System. Paper applications will not be considered. Applicants must clearly indicate how they meet the minimum qualifications and/or position specific minimum qualifications. Applicants are also encouraged to document any experience, education and/or training related to the job duties above. An assessment of these criteria may be conducted to determine the applicants who are interviewed.
STATUS OF POSTED POSITION:
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ADA Statement Ohio is a Disability Inclusion State and strives to be a model employer of individuals with disabilities. The State of Ohio is committed to providing access and inclusion and reasonable accommodation in its services, activities, programs and employment opportunities in accordance with the Americans with Disabilities Act (ADA) and other applicable laws.
Drug-Free Workplace The State of Ohio is a drug-free workplace which prohibits the use of marijuana (recreational marijuana/non-medical cannabis). Please note, this position may be subject to additional restrictions pursuant to the State of Ohio Drug-Free Workplace Policy (HR-39), and as outlined in the posting.