RN Utilization Manager II | Hybrid Day Shift

Sharp HealthCare; San Diego (CA); Hybrid; USD 144,000 - 201,000; Full time

Job summary

Sharp HealthCare in San Diego seeks a Utilization Manager II to support utilization review from admission to discharge, ensuring appropriate patient status and timely care decisions. The role emphasizes collaborative care, mentorship for new staff, and adherence to guidelines to optimize patient outcomes and revenue integrity.

You will partner with physicians, payer representatives, and interdisciplinary teams, participate in ICM conferences, monitor bed utilization, and contribute to quality

Qualifications

• Bachelor's degree in healthcare or 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.
• California RN license is required.

Responsibilities

• Perform initial and concurrent review on bed status with the care team and payer.
• Identify and escalate cases not meeting admission criteria and mitigate denials.
• Coordinate transfer of out-of-network patients when indicated.
• Maintain records and statistics: bed days, discharges, readmissions.
• Participate in ICM care conferences and system-level utilization activities.
• Maintain confidentiality of Utilization Management information and ensure timely documentation.

Skills

Collaboration

Communication

Professionalism

Healthcare IT

Education

Bachelor's Degree in Healthcare or related field

California RN license

Job description

Sharp HealthCare in San Diego seeks a Utilization Manager II to support utilization review from admission to discharge, ensuring appropriate patient status and timely care decisions. The role emphasizes collaborative care, mentorship for new staff, and adherence to guidelines to optimize patient outcomes and revenue integrity.

You will partner with physicians, payer representatives, and interdisciplinary teams, participate in ICM conferences, monitor bed utilization, and contribute to quality