Medical Review Rn Jobs Near Me

What You'll Do:

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

Clinical and Case Management: 

• 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.

Community Engagement & Education: 

• 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

Administrative and Liaison Support: 

• 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

UNUSUAL WORKING CONDITIONS: May require travel

Position 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. 

Or 

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:

• 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)

All eligible applications shall be reviewed considering 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: Analyzations, Attention to Detail, Collaboration, Consultation, Verbal Communication, Written Communications

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 five (5) working days of being requested will cause the applicant to be eliminated from further consideration. 

Please note that a transcript is considered "official" only if it is an original copy from the educational institution and includes an institutional watermark, ink stamp or embossed stamp. Transcripts printed from the institution's website will not be accepted. ODH reserves the right to assess the academic credibility of an educational entity's award of a putative degree.

If you are using education or coursework to meet the minimum qualifications for this position, an official transcript must be attached prior to submitting your application.