On-Site Physician Advisor: Utilization & Leadership

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

Benefits offered by this job

Medical, Dental, Vision plans

Paid Time Off and Sick Leave

401k/403B with Employer Match

Tuition Assistance – $5,250/year

Student Debt Pay Down – $10,000

Life Insurance

Job summary

Sentara Virginia Beach General Hospital in Virginia Beach, VA is seeking a Physician Advisor to lead medical necessity reviews and support utilization management. The role involves collaboration with hospital leadership, medical staff, and Care Management to ensure compliant status determinations and efficient denial management processes.

Qualified candidates hold an MD or DO with board certification, an active Virginia license, and at least 3 years of hospital-based clinical experience.

Qualifications

• MD or DO degree from an accredited medical school.
• Board certification in specialty at time of hire (Required).
• Active Virginia medical license (Required).
• Minimum of 3 years clinical experience; hospital-based preferred.
• Familiarity with CMS regulations and utilization review requirements.

Responsibilities

• Perform timely and compliant medical necessity reviews with clear documentation.
• Facilitate denials management through peer-to-peer discussions and appeals support.
• Educate physicians and leaders on utilization review and regulatory requirements.
• Collaborate with hospital leadership, medical staff, and ICM to support system initiatives.
• Attend Hospital Utilization Management committees and other meetings.

Skills

Regulatory compliance

Utilization review

Peer-to-peer reviews

Physician engagement

CMS regulations

Education

MD or DO

Residency completed

Tools

EMR systems

CDI knowledge

Coding practices

Job description

Sentara Virginia Beach General Hospital in Virginia Beach, VA is seeking a Physician Advisor to lead medical necessity reviews and support utilization management. The role involves collaboration with hospital leadership, medical staff, and Care Management to ensure compliant status determinations and efficient denial management processes.

Qualified candidates hold an MD or DO with board certification, an active Virginia license, and at least 3 years of hospital-based clinical experience.