Heat a large high-sided skillet over medium-high heat. Add sausage and cook, breaking the meat into small pieces as it cooks, for approximately 5-6 minutes. Once sausage is no longer pink, remove from heat and carefully drain excess grease from pan.
Return skillet to heat. Add water and scrape up brown bits from the bottom of the pan with a spatula. Reduce heat to medium and add shredded cabbage, carrots, sesame oil, ginger, and green onions. Season with salt and black pepper, to taste, and cook, stirring frequently, until the cabbage wilts and the carrot softens approximately 4-5 minutes.
Add rice vinegar and coconut aminos and stir to combine. Cook another 1-2 minutes or until heated through. Remove from heat and transfer to a serving platter or bowl. Sprinkle with toasted sesame seeds, if using, and serve immediately