AI Success Stories: How Sharp HealthCare and MCG Are Transforming Utilization Management and Reducing Hospital Burdens

Sharp HealthCare and MCG Leaders Share AI-Driven Utilization Management Success at CMSA 2025

At the 2025 CMSA Annual Conference in Dallas, Texas, healthcare leaders from MCG Health and Sharp HealthCare will present on how AI technology is transforming utilization management (UM) processes. The event, scheduled for June 24-27, 2025, will highlight practical strategies for improving hospital UM efficiency and reducing administrative workloads.

Sharp HealthCare’s Experience with AI in Utilization Management

Tonya Soroosh, System Director of Case Management at Sharp HealthCare, will lead a session titled "Unleashing AI for UM: The Critical Role of Change Management" on June 26 from 2:30 p.m. to 3:30 p.m. CDT. She will share Sharp HealthCare’s firsthand experience selecting, implementing, and training staff on MCG’s AI tools combined with evidence-based guidelines. This approach helps ensure appropriate care decisions and minimizes unnecessary denials.

Key outcomes from Sharp’s AI adoption include:

• Reducing case review times by 80%, bringing average reviews down to under three minutes
• Improved case prioritization, potentially saving $6.95 million related to observation to inpatient status conversions

Ms. Soroosh will also discuss effective change management methods critical to successful AI integration and maximizing organizational impact.

"Hospital utilization management must adopt AI and language processing technology to keep pace with industry demands," said Ms. Soroosh. "Relying solely on increasing full-time staff is no longer effective. We’re excited to share Sharp’s insights on AI adoption at CMSA 2025."

MCG Health’s Insights into AI Adoption

Before Sharp HealthCare’s presentation, MCG Health experts Abbey Armstead, Senior Manager of Technical Product Management, and Rick Klingler, Senior Account Executive, will host a session on June 25 from 11:00 a.m. to 12:30 p.m. CDT during the Lunch Symposia #2. Their talk, "AI Adoption for Utilization Management: Transforming Reviews for Enhanced Accuracy, Revenue Protection, and Team Satisfaction," will cover practical tips for implementing AI solutions to optimize hospital revenue cycle operations and documentation.

About Sharp HealthCare

Sharp HealthCare is San Diego’s leading healthcare provider, serving a broad community with a mission to improve health outcomes. Operating four acute-care hospitals, three specialty hospitals, and multiple affiliated medical groups, Sharp focuses on high reliability and zero harm policies for patients, employees, and physicians. Its nonprofit status ensures that all resources are dedicated to delivering quality, patient-centered care supported by the latest medical technology.

About MCG Health

MCG Health, part of the Hearst Health network, offers unbiased clinical guidance and AI technology that helps healthcare organizations simplify workflows and make confident care decisions. Their solutions support improved clinical outcomes and financial performance through evidence-based tools and excellent customer service.

About Hearst Health

Hearst Health delivers essential intelligence and software that enhance the quality, safety, and efficiency of healthcare. With a 40-year history, Hearst Health companies—including FDB, Homecare Homebase, MCG, MHK, QGenda, and Zynx Health—provide tools that empower healthcare participants throughout the care journey.

For more information on the 2025 CMSA Annual Conference and registration details, visit the CMSA official website.