Nurse Case Manager - Internal (Medical Review Nurse - PN 20014026)

About the role

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.

Responsibilities

• 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.
• 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.

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 and all of the following bulleted criteria:
  • 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 and all of the following bulleted criteria:
  • 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
  • 24 mos. exp. in nursing, which included 3 mos. trg. or 3 mos. exp, in community health or public health nursing & 3 mos. trg. or 3 mos. exp in data collection & analysis
  • 1 course or 3 mos. exp. in operation of personal computer
• Equivalent of Minimum Class Qualifications for Employment noted above may be substituted for the experience required, but not for the mandated licensure.

Additional Qualifications

• Applications of those who meet the minimum qualifications will be further evaluated against the following criteria: qualifications, experience, education, active disciplinary record, and work record.

Job Skills

• Nursing
• Technical Skills: Health Administration, Medical Records, Nursing, Public Health, Public Relations
• Professional Skills: Analysis, Attention to Detail, Collaboration, Consultation, Verbal Communication, Written Communication

Work Hours

Monday - Friday; 8am - 5pm