RN Pharmacy

Sedgwick Claims Management Services Ltd; Tennessee; Hybrid; USD 65,000 - 67,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

401K

PTO

Flexible spending account

Job summary

Sedgwick is seeking a nurse to evaluate prescribed medications to ensure patient safety and align with best practice standards. This role supports injured employees in a nontraditional clinical setting and collaborates with claims teams to deliver quality care.

We offer remote work flexibility, comprehensive benefits, and opportunities for professional development while maintaining high standards of ethics and regulatory compliance.

Qualifications

• Active unrestricted RN license in the United States required.
• Bachelor's degree in nursing (BSN) from an accredited college or university preferred.
• Certification in case management, pharmacy, rehabilitation nursing or related specialty is highly preferred.

Responsibilities

• Performs clinical assessment via information in pharmacy reports and case files, assesses patient needs.
• Evaluates patient drug usage and physician prescribing patterns.
• Evaluates overuse, underuse and misuse of prescribed medications; may recommend testing for drug diversion.
• Sends letters to prescribing physicians and refers to physician advisor as needed.
• Negotiates care levels with providers using established guidelines.
• Negotiates changes in pharmacy plan with providers.
• Consults with 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 others.
• Maintains client privacy; promotes safety and adheres to standards.

Skills

RN license

Education

BSN

Job description

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 Certified as a Great Place to Work® Fortune Best Workplaces in Financial Services & Insurance RN Pharmacy As a nurse at Sedgwick, you can build a meaningful and rewarding career while advocating for patients in a nontraditional clinical setting. Apply your medical/clinical or rehabilitation knowledge and experience to assist in the management of complex medical conditions, treatment planning and recovery from illness or injury. Work in the best of both worlds - a rewarding career making an impact on the health and lives of others, and a remote work environment. Enjoy flexibility in your career path while advocating for the most effective and efficient medical treatment for injured employees in a non-traditional setting. Enable our Caring counts® mission supporting injured employees from some of the world’s best brands and organizations. Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service. Celebrate your career achievements and each other through professional development opportunities, continuing education credits, team building initiatives and more. Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs.

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.

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.

Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.

Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.

Sedgwick is the world’s leading risk and claims administration partner, which helps clients thrive by navigating the unexpected. The company’s expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration, and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape. For more, see sedgwick.com