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Nurse Case Manager (Medical Review Nurse) PN: 20014031

State of Ohio Jobs – Columbus, OH

Primary Location: United States of America-OHIO-Franklin County Work Locations: Health Department Building 246 N High St 1st Floor Columbus 43215 Organization: Health Classified Indicator: Classified Bargaining Unit / Exempt: Bargaining Unit Schedule: Full-time Work Hours: 8:00am - 5:00pm Compensation: $28.31/hourly Unposting Date: Jul 9, 2019, 10:59:00 PM Job Function: Nursing Agency Contact Name: Maria Kapenda Agency Contact Information: [email protected]

Nurse Case Manager (Medical Review Nurse) PN: 20014031

(190003SB) Job Duties
Independently determines Children with Medical Handicaps (CMH) eligibility and authorizes or denies health care services (e.g., diagnostic, treatment or service coordination) for children with special health care needs (CSHCN) applying for or enrolled in the CMH program utilizing case management software (CMACS) from CMH central office and/or from remote locations (e.g., local health department, provider offices). Independently analyzes and interprets health, medical and nursing data, draws conclusions about service delivery problems and determines most appropriate plan of care based on medical reports and physician requested services. Accesses computer to retrieve client information, evaluates client profiles and inputs data related to individual cases and services for case processing. Researches diagnoses and determines services appropriate for diagnosis including but not limited to medical equipment, orthotics, prosthetics, and orthodontia. Reviews comprehensive health care plans and service delivery for compliance with CMH program rules and operational guidelines in a variety of settings. Provides technical assistance to assist with implementation of authorized health services for CSHCN in relationship to approved standards of care and regulations. Interprets and assesses medical plans of treatment determining most appropriate plan of action for the childs authorized services. Monitors ongoing need and effectiveness of authorized services (e.g., reviews and interprets referrals, interprets diagnoses, tests, medical policy and guidelines). Assess and obligates the expenditures of state, federal and local funds for services eligible for CMH payment. Uses 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). Consults (e.g., with supervisors, managing physicians, local health departments) to assure the quality care for CSHCN served by CMH. Identifies potential areas of inappropriate utilization in accordance with CMH policies and make recommendations to the supervisor of needed follow-up. Works in partnership with nurse case manager field, to ensure assigned case load is managed and processed according to CMH policies and timelines.
Maintains personal contact by telephone, in writing and/or extensive site visits (i.e., travels by car throughout assigned area in Ohio) with various individuals (e.g., local public health nurses, administrators, local governmental officials, physicians, billing agencies, families) to provide advice, technical assistance and consultation related to the CMH program and care of CSHCN. Interprets, explains, carries out and informs local agencies and providers of changes in the various policies, regulations, standards and procedures of the state CMH program. Provides extensive orientation to providers and their staff related to CMH policies and procedures including billing for services. Plans, coordinates, and participates in educational workshops, seminars and nursing care conferences on topics related to care of CSHCN. Provides orientation of CMH to various providers (e.g., physicians, pharmacies, dentist, service coordinators, PHNs). Assists in local service delivery problems by communicating with various individuals (e.g., social workers, resource payment specialists and other CMH administrative central office personnel). Resolves sensitive, confidential complaints, and answers questions from families, providers and community agencies in a professional manner. Maintains client records in a confidential manner using established national, state and CMH guidelines. Writes CMH field reports as assigned. Assists supervisor in updating policies/procedures, standards, and forms for the CMH program as assigned.
Performs administrative and support tasks (e.g., answers telephones, operates photocopier to make copies, sends and receives facsimiles, and maintains client physical and electronic record). Serves as a liaison to governmental, private section, families and other state programs as directed. Attends workshops, conference and training related to the CMH program, CSHCN and/or family health programs. As assigned, serves as a member of the Disaster Recovery/Business Resumption team, Incident Response Team, or similar public health response team which may include the conduct of operations on a 24/7 basis at remote locations.
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; 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 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 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; 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.
Knowledge of nursing; pediatrics & special health care needs of children; agency policies & procedures applicable to medical services for children with multiple handicaps or with special health care needs*; federal &/or state laws, rules, policies &/or procedures applicable to medical plans of treatment*; public relations. Skill in operation of personal computer; office equipment (e.g., telephone; photocopier; facsimile machine)*. Ability to read, interpret, comprehend & deal with a wide variety of complex written or verbal medical material & determine course of action; answer sensitive & confidential inquiries & resolves complaints from public, families, medical professionals & government officials concerning medical diagnosis, treatment or service; prepare, accumulate & safeguard data or information for medical confidential oral & written reports. ALL ANSWERS TO THE SUPPLEMENTAL QUESTIONS MUST BE SUPPORTED BY THE WORK EXPERIENCE/EDUCATION PROVIDED ON YOUR CIVIL SERVICE APPLICATION.
Applications of those who meet the minimum qualifications will be further evaluated against the following criteria:
  • Bachelors or advanced degree in Nursing;
  • At least 1 year experience in Pediatric Nursing (within past 6 years);
  • At least 1 year nursing experience working with children with special health care needs (within the past 6 years);
  • Experience providing technical assistance/consultation services to health department or other provider of child health services (e.g., hospitals, pediatric clinics, physician office);
  • Experience reviewing and authorizing medical plans of treatment;
  • 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 (medical, nursing staff, parents);
  • Experience working with computer software (e.g., Word, PowerPoint);
  • Experience in public/community/home health nursing.
All eligible applications shall be reviewed considering the following criteria: qualifications, experience, education, active disciplinary record, and work record.
TRAINING AND DEVELOPMENT REQUIRED TO REMAIN IN THE CLASSIFICATION AFTER EMPLOYMENT: Biennial renewal of license to practice as Registered Nurse.
UNUSUAL WORKING CONDITIONS: May require travel.
EDUCATIONAL TRANSCRIPT REQUIREMENTS: Official educational transcripts are required for all post-high school educational accomplishments, coursework or degrees claimed on the application. Applicants will be required to submit an official transcript prior to receiving a formal offer of employment. Failure to provide transcripts within 5 working days of being requested will cause the applicant to be eliminated from further consideration.
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.
Background Check Information The final candidate selected for this position will be required to undergo a criminal background check. Criminal convictions do not necessarily preclude an applicant from consideration for a position. An individual assessment of an applicant s prior criminal convictions will be made before excluding an applicant from consideration.

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