Complex Case Manager II

Job Description

RepuCare is a certified, woman-owned business (WBE) and a leading provider of medical management solutions for corporate, state and federal healthcare programs.  RepuCare provides a comprehensive benefits program including all types of insurance, generous PTO and 401K for full-time employees.
Complex Case Management Nurse performs collaborative duties to assess, plan and coordinate continuum of care for select members with complex medical or behavioral  health conditions or are at high risk in order to promote quality, cost effective care.  


  • Advanced review of admissions through on-site and telephonic review to ensure medical necessity and appropriate level of care
  • Develop, assess and adjust as necessary the care plan and promote desired outcome
  • Coordinate services between Primary Care Physician (PCP) specialist, and other medical and non-medical providers as necessary to meet the complete medical socio-economic  needs of clients. Participate in face to face visits with high risk members at point of service as needed
  • Provide to both patient and provider needed education
  • Identify related risk management quality concerns and report these scenarios to the appropriate resources
  • Data enters assessments and authorizations into the system








Job Requirements


  • 2+ years of clinical nursing or case management experience, preferably in a managed care environment
  • Minimum RN license in good standing
  • Current, active state driver's license
  • CCM (Certified Case Manager) or other clinical certification is preferred, but not required

Job Snapshot

Employment Type Full-Time
Job Type Health Care, Insurance
Education 2 Year Degree
Experience At least 2 year(s)
Manages Others No
Relocation No
Industry Healthcare - Health Services, Managed Care
Required Travel None
CareerBuilder Tip:
For your privacy and protection, when applying to a job online, never give your social security number to a prospective employer, provide credit card or bank account information, or perform any sort of monetary transaction. Learn more.

By applying to a job using you are agreeing to comply with and be subject to the Terms and Conditions for use of our website. To use our website, you must agree with the Terms and Conditions and both meet and comply with their provisions.

Complex Case Manager II

Enter notes about this job: