Physician Advisor - Sentara Princess Anne

Sentara Health

Northampton

On-site

GBP 27,500 - 30,000

Full time

14 days+

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Benefits offered by this job

Medical, Dental, Vision plans

Paid Time Off and Sick Leave

Paid Parental & Family Caregiver Leave

Tuition Assistance – $5,250/year

Student Debt Pay Down – $10,000

401k/403B with Employer Match

Job summary

Sentara Health is seeking an On-Site Physician Advisor to perform vital medical necessity reviews and management of denials. The ideal candidate will possess a medical doctorate, board certification, and exemplary interpersonal skills, ensuring effective collaboration within the hospital's clinical environment.

Qualifications

Must possess an unrestricted Virginia medical license.
Minimum of 3 years clinical experience preferred.
Familiarity with regulatory guidance on utilization review.

Responsibilities

Conduct medical necessity reviews and assist with denial management.
Facilitate clear communication with medical staff on regulatory requirements.
Participate in Hospital UM committees and provide education to peers.

Skills

Excellent customer service

Interpersonal skills

Communication skills

Superb written skills

Clinical documentation integrity knowledge

Knowledge of CMS regulations

Education

Medical doctorate or Doctor of Osteopathy

Completion of an accredited residency program

Board certification in specialty

Job description

2 days ago Be among the first 25 applicants

Overview:

The On-Site Physician Advisor (OSPA) conducts timely and compliant medical necessity reviews and assists with denials management (facilitating and completing peer to peers, writing appeal letters) in support of the centralized system Utilization Review (UR) process for Sentara hospital facilities. The Physician Advisor serves an important role in ensuring compliant hospital status/billing for hospital patients and strengthening relationships between Clinical Revenue Cycle, UR, hospital leadership, medical staff, and hospital ICM. The Physician Advisor interfaces directly with the medical staff, providing concurrent communication and education to attending physicians (and their APCs) regarding recommended changes in hospital status, pertinent regulatory requirements and guidance impacting the determination, as well as documentation integrity to support medical necessity of services being delivered.

City/State

Norfolk, VA

Work Shift

First (Days)

Overview:

The On-Site Physician Advisor (OSPA) conducts timely and compliant medical necessity reviews and assists with denials management (facilitating and completing peer to peers, writing appeal letters) in support of the centralized system Utilization Review (UR) process for Sentara hospital facilities. The Physician Advisor serves an important role in ensuring compliant hospital status/billing for hospital patients and strengthening relationships between Clinical Revenue Cycle, UR, hospital leadership, medical staff, and hospital ICM. The Physician Advisor interfaces directly with the medical staff, providing concurrent communication and education to attending physicians (and their APCs) regarding recommended changes in hospital status, pertinent regulatory requirements and guidance impacting the determination, as well as documentation integrity to support medical necessity of services being delivered.

As this role’s duties include significant interpersonal and relational aspects in addition to regulatory training and licensing requirements, an active and unrestricted Virginia medical license and board-certified status at the time of hire are required, as well as superb interpersonal and communication skills. Due to the collaborative and highly relational nature of this role, on-site (in person) presence is integral. Coverage at additional sites may be required, including occasional in-person responsibilities. The position reports to the Director of Regional Physician Advisors to Clinical Revenue Cycle.

Perform timely and compliant medical necessity reviews, providing clear documentation of the pertinent details of the case to satisfy regulatory requirements and directly communicating any necessary
Facilitate denials management through review of selected cases, conducting peer to peer discussion with third party payers as appropriate, and assisting with appeals letters
Work closely with hospital leadership, medical staff, and hospital ICM leaders to support system CPIs and initiatives
Attend and participate in Hospital UM committees at designated sites
Complete training and continuing education as deemed necessary
Attend and participate in educational presentations to medical staff, administration, leadership and peers
Additional functions as deemed appropriate and warranted

Minimum Requirements:

Completion of Medical doctorate or Doctor of Osteopathy degree from an accredited medical school
Completion of an accredited residency training program
Minimum of 3 years of clinical experience, hospital clinical experience strongly preferred
Active and unrestricted state Virginia medical license
Board certification in specialty required at time of hire
Possess or acquire a working knowledge of CMS regulatory guidance and requirements as they pertain to UR and site of service decisions
Possess a working knowledge of clinical documentation integrity, hospital billing and coding processes and guidelines, case mix index, and DRG assignments
Familiarity with standard published leveling criteria such as MCG/Interqual and ability to apply professional judgment and patient specific variables as may be necessary or justifiable
Familiarity with (Hospital) organization and case management operations
Excellent customer service and interpersonal skills.
Able to effectively present information, both formal and informal
Superb written and verbal communications skills
Ability to set and manage priorities
Demonstrate flexibility, teamwork, and a collaborative leadership style
Strong technical/computer skills and working knowledge of the system’s EMR

Benefits: Caring For Your Family and Your Career

Medical, Dental, Vision plans
Adoption, Fertility and Surrogacy Reimbursement up to $10,000
Paid Time Off and Sick Leave
Paid Parental & Family Caregiver Leave
Emergency Backup Care
Long-Term, Short-Term Disability, and Critical Illness plans
Life Insurance
401k/403B with Employer Match
Tuition Assistance – $5,250/year and discounted educational opportunities through Guild Education
Student Debt Pay Down – $10,000
Reimbursement for certifications and free access to complete CEUs and professional development
Pet Insurance
Legal Resources Plan
Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.

Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.

In support of our mission “to improve health every day,” this is a tobacco-free environment.

For positions that are available as remote work, Sentara Health employs associates in the following states:

Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.

Seniority level