By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve.
Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies
Work Schedule: This position is scheduled Monday through Friday, 1:00 PM - 9:00 PM CST .
Training Schedule: Initial training will be conducted Monday through Friday, 8:00 AM - 4:00 PM CST . Candidates must be available to attend training during these daytime hours before transitioning to the regular work schedule.
Note: Consistent attendance during the training period is required to ensure a successful onboarding experience.
PRIMARY PURPOSE OF THE ROLE: To utilize evidence based tools to evaluate the prescribed medications to ensure patient safety and quality standards are in alignment with best practice standards.
ARE YOU AN IDEAL CANDIDATE? We are looking for enthusiastic candidates who thrive in a collaborative environment, who are driven to deliver great work.
ESSENTIAL RESPONSIBLITIES MAY INCLUDE:
Performs clinical assessment via information in pharmacy reports and case files; assesses client's situation to include psychosocial needs, cultural implications and support systems in place.
Evaluates patient drug usage and physician prescribing patterns.
Evaluates overuse, underuse and misuse of prescribed medications and may recommend testing to determine if drug diversion is present.
Evaluates need for and recommends alternative treatment.
Sends letters as needed to prescribing physician(s) and refers to physician advisor as necessary.
Negotiates appropriate level and intensity of care through use of medical and disability duration guidelines, adhering to quality assurance standards.
Negotiates changes in pharmacy plan with providers.
Acts as a resource in consulting with the client, nursing staff and claims examiners regarding pharmacy issues.
Performs drug utilization reviews through the pharmacy benefit manager or vendor.
Communicates effectively with claims examiner, client, vendor, supervisor and other parties as needed.
Maintains client's privacy and confidentiality; promotes client safety and advocacy; and adheres to ethical, legal, accreditation and regulatory standards.
QUALIFICATIONS
Education & Licensing
Active unrestricted RN license in a state or territory of the United States required. Bachelor's degree in nursing (BSN) from an accredited college or university or equivalent work experience preferred. Certification in case management, pharmacy, rehabilitation nursing or a related specialty is highly preferred.
Experience
Four (4) years of related experience or equivalent combination of education and experience required to include two (2) years of direct clinical care OR two (2) years of case management/utilization management.
TAKING CARE OF YOU
Seeks innovative customer solutions.
Craves cutting edge opportunities.
Wants dynamic company culture.
Passion about creativity.
Seeks ongoing learning as a person and professional.
Thrives when solving challenging problems.
Wants achievements to be celebrated.
We offer a diverse and comprehensive benefits including medical, dental vision, 401K, PTO and more beginning your first day.
NEXT STEPS
If your application is selected to advance to the next round, a recruiter will be in touch.
Work environment requirements for entry-level opportunities include –
Physical: Computer keyboarding
Auditory/visual: Hearing, vision and talking
Mental: Clear and conceptual thinking ability; excellent judgement and discretion; ability to meet deadlines
As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $65,000 - $67,000. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTAO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.
The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.
