CommonSpirit Health
System VP Utilization Management
– CommonSpirit Health
Summary : The System Vice President of Utilization Management is a key member of the healthcare organization’s leadership team and is charged with meeting the organization’s goals and objectives for assuring the effective, efficient utilization of health care services. This role will be an expert on physician practice patterns, resource utilization, medical necessity, levels of care, compliance with regulations, and physician coding/documentation requirements.
Key Responsibilities :
Leadership & Strategy: Lead the System-level Utilization Management (UM) department, ensuring alignment with organizational goals, developing policies, driving continuous improvement, and guiding the UM team.
Clinical Oversight & Decision-Making: Review medical necessity, lead medical review activities, serve as clinical authority on complex cases, appeals, and exceptions.
Collaboration & Communication: Work with senior leadership, clinical teams, and external stakeholders to promote coordinated utilization management, communicate with physicians, providers, and insurance representatives, and liaise with regulatory bodies.
Cost & Quality Management: Develop cost-control strategies, monitor utilization trends, identify cost savings, and collaborate with QA and Medical Affairs to improve outcomes.
Compliance & Regulatory Oversight: Ensure UM practices adhere to state, federal, and insurance regulations, stay current on industry trends, and maintain accreditation standards.
Job Requirements :
Master’s or Post Graduate Degree from an accredited medical school.
Minimum 10 years of experience in health care delivery systems.
Minimum 5 years in physician advisory work.
Minimum 5 years in Utilization Management or collaboration with a health system.
Minimum 5 years in Revenue Cycle collaboration.
Minimum 5 years performing government, managed care, and commercial appeals.
Minimum 7 years in a director level or equivalent leadership role.
Prior VP and/or CMO experience > 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 (ABQAURP) – preferred.
Physician Advisor Sub-specialty Certification by ABQAURP – preferred.
Required Knowledge, Skills & Abilities :
Knowledge of nationally recognized medical necessity criteria.
Ability to work independently in a fast-paced environment.
Current knowledge of federal, state, and payer regulatory and contract requirements.
Previous Physician Advisor or Care Management experience; excellent communication skills.
Strong interpersonal communication skills.
Where You'll Work : At the heart of CommonSpirit Health's national office departments that provide essential support and expertise to local communities, focusing on patient care across clinical excellence, operations, finance, HR, legal, supply chain, technology, and mission integration.
Pay Range : $133.54 - $186.96 /hour
Seniority level : Executive
Employment type : Full-time
Job function : Health Care Provider
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– CommonSpirit Health
Summary : The System Vice President of Utilization Management is a key member of the healthcare organization’s leadership team and is charged with meeting the organization’s goals and objectives for assuring the effective, efficient utilization of health care services. This role will be an expert on physician practice patterns, resource utilization, medical necessity, levels of care, compliance with regulations, and physician coding/documentation requirements.
Key Responsibilities :
Leadership & Strategy: Lead the System-level Utilization Management (UM) department, ensuring alignment with organizational goals, developing policies, driving continuous improvement, and guiding the UM team.
Clinical Oversight & Decision-Making: Review medical necessity, lead medical review activities, serve as clinical authority on complex cases, appeals, and exceptions.
Collaboration & Communication: Work with senior leadership, clinical teams, and external stakeholders to promote coordinated utilization management, communicate with physicians, providers, and insurance representatives, and liaise with regulatory bodies.
Cost & Quality Management: Develop cost-control strategies, monitor utilization trends, identify cost savings, and collaborate with QA and Medical Affairs to improve outcomes.
Compliance & Regulatory Oversight: Ensure UM practices adhere to state, federal, and insurance regulations, stay current on industry trends, and maintain accreditation standards.
Job Requirements :
Master’s or Post Graduate Degree from an accredited medical school.
Minimum 10 years of experience in health care delivery systems.
Minimum 5 years in physician advisory work.
Minimum 5 years in Utilization Management or collaboration with a health system.
Minimum 5 years in Revenue Cycle collaboration.
Minimum 5 years performing government, managed care, and commercial appeals.
Minimum 7 years in a director level or equivalent leadership role.
Prior VP and/or CMO experience > 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 (ABQAURP) – preferred.
Physician Advisor Sub-specialty Certification by ABQAURP – preferred.
Required Knowledge, Skills & Abilities :
Knowledge of nationally recognized medical necessity criteria.
Ability to work independently in a fast-paced environment.
Current knowledge of federal, state, and payer regulatory and contract requirements.
Previous Physician Advisor or Care Management experience; excellent communication skills.
Strong interpersonal communication skills.
Where You'll Work : At the heart of CommonSpirit Health's national office departments that provide essential support and expertise to local communities, focusing on patient care across clinical excellence, operations, finance, HR, legal, supply chain, technology, and mission integration.
Pay Range : $133.54 - $186.96 /hour
Seniority level : Executive
Employment type : Full-time
Job function : Health Care Provider
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