Utilization Management Behavioral Health Nurse (Medicaid Health Systems Specialist

• RN) State of Ohio
• Medicaid
• 3.

7 Columbus, OH Job Details Full-time $36.01 an hour 16 hours ago Benefits Paid holidays Health insurance Dental insurance Paid time off Vision insurance Loan forgiveness Life insurance

Qualifications RN License Nursing Full Job Description What You Will Do At ODM:

Office :

Health Innovation & Quality Bureau :

Clinical Operations/Utilization Management Classification :

Medicaid Health Systems Specialist RN (PN 20046588) Pay rate : $36.01/hour

Job Overview:

As the Utilization Management Behavioral Health Nurse in the Bureau of Clinical Operations, Ohio Department of Medicaid (ODM), your responsibilities will include: Review Clinical Coverage Policies (CCPs) to ensure service requests meet medical necessities, benefit coverage rules, and applicable Ohio Administrative Code standards. Conduct validation of service decisions, including assessing whether requested behavioral health services meet required clinical criteria and documentation thresholds; verifying completeness of assessments, treatment plans, and prior authorization submissions in alignment with UM policy requirements. Assist with rules language by interpreting behavioral health service rules and CCP requirements; helping refine, clarify, or apply rule language during reviews and provider communications; ensuring decisions reflect correct interpretation of policy, coverage rationale, and service thresholds. Participate in cross-team collaboration with medical directors, reviewers, policy teams, and behavioral health leads to ensure UM consistency and alignment with statewide managed care requirements. Support provider education by identifying policy gaps, common documentation issues, or rule misinterpretations and communicating them through appropriate UM channels. Why Work for the State of Ohio 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 Free Dental, Vision and Basic Life Insurance premiums after completion of eligibility period Paid time off, including vacation, personal, sick leave and 11 paid holidays per year Childbirth, Adoption, and Foster Care leave Education and Development Opportunities (Employee Development Funds, Public Service Loan Forgiveness, and more) Public Retirement Systems (such as OPERS, STRS, SERS, and HPRS) & Optional Deferred Compensation (Ohio Deferred Compensation) Benefits eligibility is dependent on a number of factors. The Agency Contact listed above will be able to provide specific benefits information for this position. Qualifications Position requiring assessment or reassessment of clinical appropriateness of services &/or payment policies &/or related issues in regards to Medicaid health services delivery requires current & valid license as registered nurse as issued by Ohio Board of Nursing, pursuant to Sections 4723.03 & 4723.09 of Ohio revised code; additional 24 mos. exp. in nursing. For this position, besides required 24 months experience in nursing you would need to have additional 24 months experience in Behavioral Health nursing . Or for positions other than those requiring valid license as registered nurse, 24 months experience as Medicaid Health Systems Analyst, (65291) may be substituted for the experience required, but not for the mandated licensure. Or equivalent of Minimum Class Qualifications for Employment noted above may be substituted for the experience required, but not for the mandated licensure.

Technical Skills:

Nursing and Behavioral Health Nursing Professional Skills:

Critical Thinking, Collaboration, Attention to

Detail, Organizing and Planning, Verbal Communication, Written Communication, Confidentiality, Analyzation Supplemental Information Supplemental Information:

The Ohio Department of Medicaid does not provide employment-based visa sponsorship. For this position, besides required 24 months experience in nursing you would need to have additional 24 months experience in Behavioral Health nursing . Compensation is as listed on the posting unless required by legislation or union contract. Travel required, as needed. Must provide own transportation. Or, in order to operate a state vehicle, you must have a valid driver's license from state of residence. Resumes and/or attachments are not reviewed. Therefore, please provide detail in the work experience section of your application. 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.