On-Site Physician Advisor — Utilization & Compliance Leader

Sentara Health

Virginia Beach (VA)

On-site

USD 94,000 - 312,000

Full time

14 days+

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Benefits offered by this job

Medical benefits

Dental & Vision

Tuition assistance

Student debt paydown

401k with match

PTO & sick leave

Parental leave

Job summary

Sentara Princess Anne Hospital in Virginia Beach, VA is seeking a Physician Advisor to influence clinical decisions and help lead utilization review across the system. This on-site role requires collaboration with physicians, hospital leadership, and the Integrated Care Management team to ensure compliant medical necessity determinations and quality outcomes.

The ideal candidate holds an MD or DO, is board-certified, and has at least 3 years of hospital-based experience with CMS regulations, CDI

Qualifications

MD/DO degree from an accredited medical school (Required).
Active Virginia medical license (Required).
Board certification in specialty at time of hire (Required).
Minimum 3 years of clinical experience; hospital-based preferred.
Strong knowledge of CMS regulations and UR requirements.
Experience with InterQual/MCG criteria.

Responsibilities

Perform timely medical necessity reviews and document regulatory determinations.
Lead denials management with peer-to-peer discussions and appeal letters.
Collaborate with leadership and ICM to support system initiatives.
Attend Hospital Utilization Management committees and meetings.
Educate physicians and staff on utilization review and documentation integrity.
Complete required training and continuing education.
Support departmental and organizational needs as required.