CommonSpirit Health
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System VP Utilization Management
role at
CommonSpirit Health .
Job Summary The System Vice President of Utilization Management is a key member of the organization’s leadership team charged with ensuring the effective, efficient utilization of healthcare services. This role is an expert on physician practice patterns, medical necessity, levels of care, care progression, compliance with regulations, and appropriate coding and documentation.
Essential Key Responsibilities
Lead the system-level UM department, aligning with organizational goals and regulatory standards. Develop policies, procedures, and strategies that promote high-quality, cost-effective care.
Apply clinical expertise in reviewing medical necessity of services and lead medical review activities to ensure compliance with regulatory and accreditation requirements.
Collaborate with senior leadership, clinical teams, and external stakeholders to promote coordinated utilization management and communicate effectively with physicians, providers, and insurance representatives.
Develop and implement cost-control strategies that reduce unnecessary medical expenses while maintaining high-quality care and collaborate with Quality Assurance and Medical Affairs departments to improve clinical outcomes and patient safety.
Ensure UM practices adhere to all state, federal, and insurance company regulations and stay up-to-date with industry trends and best practices.
Job Requirements
Master’s or Post Graduate Degree; graduation from an accredited medical school required.
Minimum 10 years of experience working with health care delivery systems.
Minimum 5 years of experience in physician advisory, utilization management and revenue cycle collaboration.
Minimum 5 years of experience performing government, managed care, and commercial appeals.
Minimum 7 years of experience in a director level or equivalent leadership role.
Prior VP and/or CMO experience greater than 3 years, preferred.
Licensure & Certifications
Current, valid state license as a physician.
Member of the American College of Physician Advisors (ACPA) preferred.
Board Certification by the American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) preferred.
Physician Advisor Sub-specialty Certification by the American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) preferred.
Required Minimum Knowledge, Skills & Abilities
Demonstrated knowledge of nationally recognized medical necessity criteria.
Capable of working independently with a high level of performance in a rapidly changing, fast paced environment.
Current knowledge of federal, state and payer regulatory and contract requirements.
Previous Physician Advisor/Care Management or equivalent experience. Excellent communication skills – both verbal and written.
Strong interpersonal communication skills.
Where You'll Work At the heart of CommonSpirit Health’s ministry are the national office departments that provide the foundational support, resources, and expertise that empower local communities to focus on what they do best—caring for patients. Our teams bring together expertise in clinical excellence, operations, finance, human resources, legal, supply chain, technology, and mission integration.
Pay Range $133.54 - $186.96 /hour
Seniority Level Not Applicable
Employment Type Full-time
Job Function Health Care Provider
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System VP Utilization Management
role at
CommonSpirit Health .
Job Summary The System Vice President of Utilization Management is a key member of the organization’s leadership team charged with ensuring the effective, efficient utilization of healthcare services. This role is an expert on physician practice patterns, medical necessity, levels of care, care progression, compliance with regulations, and appropriate coding and documentation.
Essential Key Responsibilities
Lead the system-level UM department, aligning with organizational goals and regulatory standards. Develop policies, procedures, and strategies that promote high-quality, cost-effective care.
Apply clinical expertise in reviewing medical necessity of services and lead medical review activities to ensure compliance with regulatory and accreditation requirements.
Collaborate with senior leadership, clinical teams, and external stakeholders to promote coordinated utilization management and communicate effectively with physicians, providers, and insurance representatives.
Develop and implement cost-control strategies that reduce unnecessary medical expenses while maintaining high-quality care and collaborate with Quality Assurance and Medical Affairs departments to improve clinical outcomes and patient safety.
Ensure UM practices adhere to all state, federal, and insurance company regulations and stay up-to-date with industry trends and best practices.
Job Requirements
Master’s or Post Graduate Degree; graduation from an accredited medical school required.
Minimum 10 years of experience working with health care delivery systems.
Minimum 5 years of experience in physician advisory, utilization management and revenue cycle collaboration.
Minimum 5 years of experience performing government, managed care, and commercial appeals.
Minimum 7 years of experience in a director level or equivalent leadership role.
Prior VP and/or CMO experience greater than 3 years, preferred.
Licensure & Certifications
Current, valid state license as a physician.
Member of the American College of Physician Advisors (ACPA) preferred.
Board Certification by the American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) preferred.
Physician Advisor Sub-specialty Certification by the American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) preferred.
Required Minimum Knowledge, Skills & Abilities
Demonstrated knowledge of nationally recognized medical necessity criteria.
Capable of working independently with a high level of performance in a rapidly changing, fast paced environment.
Current knowledge of federal, state and payer regulatory and contract requirements.
Previous Physician Advisor/Care Management or equivalent experience. Excellent communication skills – both verbal and written.
Strong interpersonal communication skills.
Where You'll Work At the heart of CommonSpirit Health’s ministry are the national office departments that provide the foundational support, resources, and expertise that empower local communities to focus on what they do best—caring for patients. Our teams bring together expertise in clinical excellence, operations, finance, human resources, legal, supply chain, technology, and mission integration.
Pay Range $133.54 - $186.96 /hour
Seniority Level Not Applicable
Employment Type Full-time
Job Function Health Care Provider
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