On-Site Physician Advisor: Utilization, Denials & Quality

Sentara-9; Virginia Beach (VA); On-site; USD 94,000 - 312,000; Full time

Benefits offered by this job

Medical plans

Dental plans

Vision plans

Paid Time Off

Parental Leave

Long-Term Disability

401k with employer match

Job summary

Sentara Virginia Beach General Hospital in Virginia Beach, VA seeks an on-site Physician Advisor to influence care decisions and strengthen regulatory compliance. You will conduct medical necessity reviews, participate in denials management, and educate physicians and leaders.

Required are MD/DO, residency training, and Virginia license with board certification. Expect collaboration across Revenue Cycle, UM, and hospital leadership, with a strong focus on quality and compliant documentation.

Qualifications

• MD or DO degree from an accredited medical school.
• Completion of an accredited residency program.
• Active Virginia medical license and board certification.

Responsibilities

• Perform timely and compliant medical necessity reviews and document determinations.
• Facilitate denials management, including peer-to-peer discussions and appeals letters.
• Collaborate with hospital leadership, medical staff, and ICM to support goals.
• Educate physicians and staff on utilization review and regulatory requirements.
• Attend UM committees and participate in system initiatives.

Skills

CMS Regulations

Utilization Review

Peer-to-Peer

Medical Necessity

Education

MD/DO

Residency Completed

Board Certified

Job description

Sentara Virginia Beach General Hospital in Virginia Beach, VA seeks an on-site Physician Advisor to influence care decisions and strengthen regulatory compliance. You will conduct medical necessity reviews, participate in denials management, and educate physicians and leaders.

Required are MD/DO, residency training, and Virginia license with board certification. Expect collaboration across Revenue Cycle, UM, and hospital leadership, with a strong focus on quality and compliant documentation.