Physician Advisor: Medical Necessity & Denials

Sentara Healthcare Inc; Virginia Beach (VA); On-site; USD 180,000 - 240,000; Full time

Job summary

Sentara Healthcare Inc. seeks a Physician Advisor to conduct timely medical necessity reviews and support denials management for the centralized Utilization Review process at Sentara hospital facilities.

You will educate attending physicians on regulatory requirements, participate in hospital UM committees, and ensure documentation supports hospital billing and status decisions. On-site presence is essential across multiple sites as needed.

Qualifications

• MD/DO from an accredited medical school.
• Completion of an accredited residency training program.
• Active and unrestricted Virginia medical license.
• Board certification in specialty.

Responsibilities

• Perform timely medical necessity reviews with clear documentation.
• Facilitate denials management and assist with appeals.
• Collaborate with hospital leadership and medical staff on CPIs.
• Attend Hospital UM committees at designated sites.
• Complete required training and continuing education.
• Present information to medical staff, administration and peers.
• Support regulatory guidance on CMS and site of service decisions.

Skills

Interpersonal skills

Presentation skills

Written communication

Verbal communication

Time management

Team leadership

EMR proficiency

Education

MD/DO

Residency training

Active Virginia medical license

Board certification

Job description

Sentara Healthcare Inc. seeks a Physician Advisor to conduct timely medical necessity reviews and support denials management for the centralized Utilization Review process at Sentara hospital facilities.

You will educate attending physicians on regulatory requirements, participate in hospital UM committees, and ensure documentation supports hospital billing and status decisions. On-site presence is essential across multiple sites as needed.