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System VP Utilization Management

  • CommonSpirit Health
  • Phoenix, Arizona, Remote
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About Us

Inspired by faith. Driven by innovation. Powered by humankindness. CommonSpirit Health is building a healthier future for all through its integrated health services. As one of the nation’s largest nonprofit Catholic healthcare organizations, CommonSpirit Health delivers more than 20 million patient encounters annually through more than 2,300 clinics, care sites and 138 hospital-based locations, in addition to its home-based services and virtual care offerings.

Our Mission

As CommonSpirit Health, we make the healing presence of God known in our world by improving the health of the people we serve, especially those who are vulnerable, while we advance social justice for all. To learn more about a calling that defines and unites, please click here for more information about our mission, vision, and values.

The posted compensation range of $133.54 - $186.96 /hour is a reasonable estimate that extends from the lowest to the highest pay CommonSpirit in good faith believes it might pay for this particular job, based on the circumstances at the time of posting. CommonSpirit may ultimately pay more or less than the posted range as permitted by law.

Job ID
2025-424427
Employment Type
Full Time
Department
Administration
Hours/Pay Period
80
Weekly Schedule
Monday - Friday (8:00am - 5:00pm)
Shift
Day
Remote
Yes
Category
Executive

Job Summary and Responsibilities

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 matters regarding physician practice patterns, over and under-utilization of resources, medical necessity, levels of care, care progression, compliance with governmental and private payer regulations, and appropriate physician coding and documentation requirements.  

Under direction of the System Senior Vice President of Clinical Regulatory and Revenue Enhancement, this role will have responsibility and accountability for creating, implementing, and leading  an integrated system-wide utilization management program which includes comprehensive denials management. This role is critical to maintaining the organization’s competitive position in the healthcare market and ensuring compliance with regulatory requirements.  This role  will also be responsible for developing and implementing innovative strategies to meet the evolving needs of the healthcare industry and driving improvements in quality, patient satisfaction, and operational efficiency.  

As a member of the senior leadership team, the System Vice President of Utilization management will contribute to high-level organizational decision-making, working closely with other executives and clinical leaders to align utilization management practices with overall business goals. This role will also be expected to drive a culture of continuous improvement, ensuring the organization remains at the forefront of industry best practices in utilization management and patient care.  

Essential Key Responsibilities: 

  • Leadership & Strategy: Lead the System-level Utilization Management (UM) department, ensuring alignment with organizational goals and regulatory standards. Develop and implement policies, procedures, and strategies that promote high-quality, cost-effective care while enhancing operational efficiencies. Drive continuous improvement initiatives, establish key performance indicators (KPIs) to evaluate UM effectiveness, and provide guidance and mentoring to UM team members, including physicians, clinical staff, and administrative staff.
  • Clinical Oversight & Decision-Making: Apply clinical expertise in reviewing and overseeing the medical necessity of healthcare services, treatments, and procedures. Lead medical review activities, ensuring compliance with regulatory and accreditation requirements, and serve as the clinical authority on complex cases, appeals, and exceptions, ensuring decisions are made based on medical necessity and best practices.
  • Collaboration & Communication: Collaborate with senior leadership, clinical teams, and external stakeholders to promote a coordinated approach to utilization management. Communicate effectively with physicians, healthcare providers, and insurance representatives to resolve issues related to coverage, care management, and treatment options. Act as a liaison between the organization and external regulatory bodies to ensure compliance with healthcare laws and policies.
  • Cost & Quality Management: Develop and implement cost-control strategies that reduce unnecessary medical expenses while maintaining high-quality care. Monitor utilization trends and identify opportunities for cost savings through appropriate management of healthcare resources. Collaborate with the Quality Assurance and Medical Affairs departments to improve clinical outcomes and patient safety.
  • Compliance & Regulatory Oversight: Ensure UM practices adhere to all state, federal, and insurance company regulations, as well as accreditation standards (e.g., NCQA, URAC). Stay up-to-date with healthcare regulations, industry trends, and best practices in utilization management.

Job Requirements

Education & Experience:

  • Master’s or Post Graduate Degree with graduation from an accredited medical school required.  
  • Minimum 10 years of experience working with health care delivery systems, required. 
  • Minimum 5 years experience  in physician advisory, required 
  • Minimum 5 years of experience working within or in collaboration with Utilization Management  for a health system, required. 
  • Minimum 5 years of experience working within or in collaboration with Revenue Cycle for a health system, required. 
  • Minimum 5 years of experience performing government, managed care, and commercial appeals required. 
  • Minimum 7 years of experience in a director level, or equivalent leadership role, required. 
  • 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. 

#LI-CSH

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.

Guided by our faith-based values, the national office fosters consistency, alignment, and innovation across CommonSpirit. By centralizing expertise and leveraging economies of scale, we enable each location to operate efficiently while maintaining flexibility to address unique local community needs. From advancing digital solutions to driving health equity, these departments extend the healing presence of humankindness everywhere we serve.

Total Rewards

Depending on the position offered, CommonSpirit Health offers a generous benefit package, including but not limited to medical, prescription drug, dental, vision plans, life insurance, paid time off (full-time benefit eligible team members may receive a minimum of 14 paid time off days, including holidays annually), tuition reimbursement, retirement plan benefit(s) including, but not limited to, 401(k), 403(b), and other defined benefits offerings, as may be amended from time to time. For more information, please visit our Total Rewards

Unless directed by a Collective Bargaining Agreement, applications for this position will be considered on a rolling basis. CommonSpirit Health cannot anticipate the date by which a successful candidate may be identified.

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CommonSpirit Health™ is an Equal Opportunity/Affirmative Action employer committed to a diverse and inclusive workforce. All qualified applicants will be considered for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, marital status, parental status, ancestry, veteran status, genetic information, or any other characteristic protected by law. For more information about your EEO rights as an applicant, please click here [PDF].

CommonSpirit Health™ will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c). External hires must pass a post-offer, pre-employment background check/drug screen. Qualified applicants with an arrest and/or conviction will be considered for employment in a manner consistent with federal and state laws, as well as applicable local ordinances, ban the box laws, including but not limited to the San Francisco and Los Angeles Fair Chance Ordinances. If you need a reasonable accommodation for any part of the employment process, please contact us by telephone at (415) 438-5575 and let us know the nature of your request. We will only respond to messages left that involve a request for a reasonable accommodation in the application process. We will accommodate the needs of any qualified candidate who requests a reasonable accommodation under the Americans with Disabilities Act (ADA). CommonSpirit Health™ participates in E-Verify.