Apply on Employer Site

State of Ohio · 4 weeks ago

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

United States of America-OHIO-Franklin County

Full-time

Onsite

Entry, Mid Level

$34.96/hr - $36.65/hr

2+ years exp

The Ohio Department of Health is dedicated to advancing the health and well-being of all Ohioans. They are seeking a Nurse Case Manager to assess medical applications, determine eligibility for services, and coordinate care strategies for children with special health care needs.

GovernmentOffice Administration

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

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

Qualification

Registered Nurse LicensePediatric Nursing ExperienceCase Management ExperienceCommunity Health NursingData CollectionAnalysisTechnical AssistanceMicrosoft OfficeConsultationAttention to DetailCollaborationVerbal CommunicationWritten Communication

Required

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

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

Preferred

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 adults health services (e.g., hospitals, pediatric clinics, physician's 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 (e.g., may include durable medical equipment/orthotics/prosthetics/orthodontic services/therapies)

Certified Nurse Case Manager/ Discharge Planner or Certified Pediatric Nurse

Experience in analyzing health related data to prepare reports (e.g., quality assurance/technical reports, medical reports)

Experience providing education or training to various groups (e.g., medical groups, nursing staff, parents, young adults)

Experience with computer software (e.g., Microsoft Office: Word, PowerPoint)