RN Utilization Manager II — Hybrid Care Leadership

Sharp; Northern, San Diego (KY, CA); Hybrid; USD 95,000 - 132,000; Full time

Job summary

Sharp HealthCare in California is seeking a Utilization Manager II to support the System Integrated Care Management team. The role focuses on utilization review from admission through discharge, coordinating with physicians, payers, and care teams to optimize patient status and reduce denials.

Requires a Bachelor's in healthcare or related field, CA RN license, and 3 years in utilization management or case management, plus 3 years acute care nursing.

Qualifications

• Bachelor’s degree in healthcare or a related field.
• 3 years utilization management or case management within a hospital or payer setting.
• 3 years acute care nursing experience.
• 2 years recent clinical experience as defined by the CBA.
• CA RN license required.
• Experience with Milliman Care Guidelines (MCG) preferred.
• Knowledge of federal and state utilization management regulations preferred.
• ACM or CCM certifications preferred.

Responsibilities

• Perform initial and concurrent review on bed intent or bedded patients.
• Collaborate with ED, attending physicians, and physician advisor.
• Identify and escalate cases not meeting admission criteria.
• Review hospitalized patients with Physician Advisor and UR chairperson.
• Maintain records and statistics (bed days, discharges, readmissions).
• Ensure timely documentation.
• Coordinate transfer of out-of-network patients when indicated.
• Maintain confidentiality of UR information.
• Participate in ICM Care Conferences.
• Work with health care teams to facilitate UR process.
• Refer high-risk or long-stay cases to UR Manager or Physician Advisor.
• Participate in system/site UR activities.
• Maintain a log of high-risk patients.

Skills

Utilization Management

Case Management

Acute care nursing experience

MCG knowledge

Education

Bachelor's Degree in Healthcare or related field

CA Licensed Registered Nurse (RN)

Job description

Sharp HealthCare in California is seeking a Utilization Manager II to support the System Integrated Care Management team. The role focuses on utilization review from admission through discharge, coordinating with physicians, payers, and care teams to optimize patient status and reduce denials.

Requires a Bachelor's in healthcare or related field, CA RN license, and 3 years in utilization management or case management, plus 3 years acute care nursing.