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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 Field Case Manager This Field Case Manger will cover our Raleigh, NC region and must live in this area in order to be considered. Must be and RN and have as least 1.5 years of prior Field Case Manager workers compensation experience. PRIMARY PURPOSE OF THE ROLE: Sedgwick Field Case Managers work face to face with their injured workers and medical providers to facilitate; though advocacy, progressive medical treatment, and timely return-to-work; while acting as a liaison and providing communication between all involved parties. While frequent travel is required, you will maintain a home-based office. ARE YOU AN IDEAL CANDIDATE? We are looking for enthusiastic candidates who thrive in a collaborative environment, who are driven to deliver great work. - 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 that allows face to face interaction with injured workers and medical professionals. - Enjoy flexibility and autonomy in your daily work, your location, and 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. . ESSENTIAL RESPONSIBLITIES MAY INCLUDE - Serve as patient advocate to support, guide and coordinate care for injured workers, families and caregivers as they navigate through the recovery process. - Assist injured workers in achieving recovery and autonomy through advocacy, communication, education, identification of service resources and service facilitation. - Identify appropriate providers and facilities throughout the continuum of services, while ensuring that available resources are being used in a timely and cost-effective manner in order to obtain optimum value for both the client and the reimbursement source EDUCATION AND LICENSING RN licensure required. Valid driver’s license required. High speed internet required. TAKING CARE OF YOU BY - Offering a blended work environment. - Supporting meaningful work that promotes critical thinking and problem solving. - Providing on-going learning and professional growth opportunities. - Promoting a strong team environment and a culture of support. - Recognizing your successes and celebrating your achievements. - We offer a diverse and comprehensive benefits package including: - Three Medical, and two dental plans to choose from. - Tuition reimbursement eligible. - 401K plan that matches 50% on every $ you put in up to the first 6% you save. - 4 weeks PTO your first full year. NEXT STEPS If your application is selected to advance to the next round, a recruiter will be in touch. #nurse #fieldcasemanager Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace. If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! 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.

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description We are seeking a Clinical Pharmacist to support medication adherence initiatives and chronic disease management for a large healthcare population. In this role, you will conduct targeted outreach to members, providers, and pharmacies to address medication-related barriers, improve adherence, and optimize treatment outcomes. The Clinical Pharmacist plays a critical role in helping improve outcomes for patients with chronic conditions such as diabetes, hypertension, and hyperlipidemia by performing medication therapy reviews, identifying care gaps, and collaborating with providers. This position requires strong clinical knowledge, excellent communication skills, and the ability to manage a high volume of outreach in a remote environment. Key Responsibilities - Member & Provider Outreach: - Conduct pharmacist-led outreach to members, providers, and pharmacies to identify and resolve medication-related barriers. - Perform 40+ outreach encounters per day with the goal of ensuring multiple member engagement points annually. - Provide education to members regarding medication use, adherence strategies, and chronic disease management. - Collaborate with providers to support medication access, therapy changes, and adherence solutions. - Clinical Review & Medication Management: - Perform Medication Therapy Reviews (MTRs) and provide clinical recommendations to optimize therapy. - Identify medication adherence issues and recommend interventions to improve outcomes. - Support the transition of members from uncontrolled to controlled chronic disease status through medication adherence strategies. - Utilize payer-approved population health tools and adherence platforms to prioritize outreach. - Documentation & Reporting: - Accurately document outreach, interventions, and clinical recommendations in required systems and tracking tools. - Maintain timely and compliant documentation aligned with quality reporting requirements. - Monitor progress toward performance and quality goals. - Collaboration & Quality Improvement: - Participate in scheduled performance and quality review meetings. - Work collaboratively with population health teams, providers, and operations to address medication access and adherence barriers. - Support initiatives aimed at improving healthcare quality measures and closing care gaps. Qualifications - Doctor of Pharmacy (PharmD) degree. - Active, unrestricted California Pharmacist license. - Strong clinical knowledge of chronic disease management including diabetes, hypertension, and hyperlipidemia. - Experience with medication therapy management (MTM), adherence strategies, and barrier assessments. - Ability to manage high-volume outreach (40+ encounters daily) in a remote environment. - Excellent communication and interpersonal skills when engaging with patients, providers, and care teams. - Strong organizational and documentation skills. Preferred Qualifications - Board Certification (e.g., BCPS, BCGP). - Experience working with Medicare Advantage, Medicaid, or Stars quality programs. - Background in population health, care gap closure, or medication adherence programs. - Familiarity with clinical guidelines related to diabetes, hypertension, and lipid management. - Experience using population health or quality reporting platforms (e.g., Cozeva or similar systems). Work Environment - 100% Remote position. - Must be available during Pacific Standard Time business hours (8:00 AM – 5:00 PM PST). - High-volume outreach role requiring strong time management and documentation accuracy.

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Information Schedule: Monday–Friday 8:00am-5:00pm EST Location: 100% Remote (U.S. only) About Us American Health Holding, Inc. (AHH), a division of Aetna/CVS Health, is a URAC-accredited medical management organization founded in 1993. We provide flexible, cost-effective care management solutions that promote high-quality healthcare for members. Position Summary Join a team that’s making a difference in the lives of patients facing complex medical journeys. As a Utilization Management (UM) Nurse Consultant specializing in Medical Review, you’ll play a vital role in ensuring members receive timely, medically necessary care through thoughtful clinical review and collaboration with providers. This fully remote position offers the opportunity to apply your clinical expertise in a fast-paced, desk-based environment where precision, communication, and compassion intersect. Key Responsibilities - Utilizes clinical experience and skills in a collaborative process to implement, coordinate, monitor and evaluate medical review cases. - Applies the appropriate clinical criteria/guideline and plan language or policy specifics to render a medical determination to the client. - Applies critical thinking, evidenced based clinical criteria and clinical practice guidelines. Med Review nurses use specific criteria to authorize procedures/services or initiate a Medical Director referral as needed. - Assists management with training new nurse reviewers/business partners or vendors to include initial and ongoing mentoring and feedback. - Actively cross-trains to perform reviews of multiple case types to provide a flexible workforce to meet client needs. - Recommends, tests, and implements process improvements, new audit concepts, technology improvements, etc. that enhance production, quality, and client satisfaction. - Must be able to work independently without personal distractions to meet quality and metric expectations. Remote Work Expectations - This is a 100% remote role; candidates must have a dedicated workspace free of interruptions. - Dependents must have separate care arrangements during work hours, as continuous care responsibilities during shift times are not permitted. Required Qualifications - Active, unrestricted RN license in your state of residence with multistate/compact licensure privileges. Ability to obtain licensure in non-compact states as needed. - Minimum 3 years of clinical experience. - 5 years demonstrated to make thorough independent decisions using clinical judgement. - 5 Years proficient use of equipment experience including phone, computer, etc. and clinical documentation systems. - 1+ Year of Utilization Review Management and/or Medical Management experience. - Commitment to attend a mandatory 2-week training (Monday–Friday, 8:30am–5:00pm EST) with 100% participation. Preferred Qualifications - Experience with interpreting Plan Language, Policies, and Benefits to determine medical necessity. - MCG Milliman, InterQual, CPB or other criteria guideline application experience is preferred. Education - Associate's degree in nursing (RN) required, BSN preferred. Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $29.10 - $62.32 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include: - Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan. - No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. - Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. For more information, visit https://jobs.cvshealth.com/us/en/benefits We anticipate the application window for this opening will close on: 03/19/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.