Physician Advisor, Hospital Utilization & Denials

NEJM; Suffolk (VA); On-site; USD 180,000 - 240,000; Full time

Job summary

Sentara is seeking a Physician Advisor to conduct timely and compliant medical necessity reviews within its centralized Utilization Review (UR) process. You will educate attending physicians on regulatory requirements, support denials management, and collaborate with hospital leadership to ensure compliant status and billing for hospital patients.

The role requires an active Virginia medical license, board certification, and at least 3 years of hospital clinical experience.

Qualifications

• Active Virginia medical license is required.
• Board certification in specialty required at time of hire.
• Minimum of 3 years of clinical hospital experience.
• Working knowledge of CMS regulatory guidance for UR and site of service decisions.
• Working knowledge of clinical documentation integrity, hospital billing and coding.

Responsibilities

• Perform timely, compliant medical necessity reviews with clear documentation.
• Facilitate denials management and assist with appeals letters.
• Collaborate with hospital leadership, medical staff, and ICM to support CPIs and initiatives.
• Attend Hospital UM committees at designated sites and participate in education to staff.

Skills

Interpersonal skills

Communication

Prioritization

Team leadership

Regulatory knowledge

CMS guidance familiarity

Coding/billing knowledge

EMR proficiency

Clinical experience

Education

MD/DO from accredited medical school

Residency training program

Tools

EMR system proficiency

Job description

Sentara is seeking a Physician Advisor to conduct timely and compliant medical necessity reviews within its centralized Utilization Review (UR) process. You will educate attending physicians on regulatory requirements, support denials management, and collaborate with hospital leadership to ensure compliant status and billing for hospital patients.

The role requires an active Virginia medical license, board certification, and at least 3 years of hospital clinical experience.