Physician Advisor - Sentara Virginia Beach General Hospital

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

Physician Advisor – Sentara Virginia Beach General Hospital (Virginia Beach, VA)

City/State Virginia Beach, VA. Work Shift First (Days). Overview: Make a broader impact beyond patient care and help shape healthcare delivery at Sentara Health. As a Physician Advisor, you'll leverage your clinical expertise to influence patient outcomes, support physician engagement, and drive quality, compliance, and operational excellence while partnering with physicians and leaders across the health system. The On‑Site Physician Advisor at Sentara Virginia Beach General Hospital in Virginia Beach, Virginia, conducts timely and compliant medical necessity reviews and assists with denials management, including peer‑to‑peer discussions and appeal letters, in support of Sentara's centralized Utilization Review (UR) process. The Physician Advisor plays a critical role in ensuring appropriate patient status determinations, supporting compliant billing practices, and strengthening collaboration among Clinical Revenue Cycle, Utilization Review, Integrated Care Management (ICM), hospital leadership, and medical staff. This role interfaces directly with physicians and advanced practice providers, providing concurrent education and guidance regarding hospital status, regulatory requirements, documentation integrity, and medical necessity. Due to the highly collaborative and relationship‑driven nature of the role, full‑time on‑site presence is required. Coverage at additional Sentara facilities may occasionally be required. This position reports to the Director of Regional Physician Advisors, Clinical Revenue Cycle.

Key Responsibilities

• Perform timely and compliant medical necessity reviews and provide clear documentation supporting regulatory requirements and status determinations.
• Facilitate denials management through case reviews, peer‑to‑peer discussions with payers, and assistance with appeal letter preparation.
• Collaborate with hospital leadership, medical staff, and ICM leaders to support system initiatives and performance goals.
• Attend and participate in Hospital Utilization Management (UM) Committees and other designated meetings.
• Provide education to physicians, leaders, and staff regarding utilization review, documentation integrity, and regulatory requirements.
• Complete required training and continuing education.
• Support additional responsibilities as appropriate to departmental and organizational needs.

Education

• Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) degree from an accredited medical school (Required)
• Completion of an accredited residency training program (Required)

Experience

• Minimum of 3 years of clinical experience required; hospital‑based clinical experience preferred.
• Working knowledge of CMS regulations and requirements related to utilization review and site‑of‑service determinations.
• Knowledge of clinical documentation integrity (CDI), hospital billing and coding practices, case mix index (CMI), and DRG assignment methodologies.
• Familiarity with InterQual, MCG, or similar level‑of‑care criteria and the ability to apply clinical judgment in complex cases.
• Familiarity with hospital operations and case management processes.
• Strong customer service and interpersonal skills.
• Effective presentation and physician education skills.
• Excellent written and verbal communication abilities.
• Ability to manage competing priorities and work independently.
• Demonstrated flexibility, teamwork, and collaborative leadership.
• Proficiency with EMR systems and related technology tools.

Licensure & Certification

• Active and unrestricted Virginia medical license (Required)
• Board certification in specialty at time of hire (Required)

Compensation

We provide market‑competitive compensation packages, inclusive of base pay, incentives, and benefits. The base pay range for full‑time employment is $93,600.00 - $312,000.00 annually. Additional compensation may be available for this role, such as shift differentials, standby/on‑call pay, shift premiums, extra‑shift incentives, or bonus opportunities. Compensation within the range may vary based on qualifications, experience, location, market conditions, and business needs. Note: If an annual salary is posted, it is based on a full‑time colleague working 2,080 hours annually.

Benefits

• Medical, Dental, Vision plans
• Adoption, Fertility and Surrogacy Reimbursement up to $10,000
• Paid Time Off and Sick Leave
• Paid Parental & Family Caregiver Leave
• Emergency Backup Care
• Long‑Term, Short‑Term Disability, and Critical Illness plans
• Life Insurance
• 401k/403B with Employer Match
• Tuition Assistance – $5,250/year and discounted educational opportunities through Guild Education
• Student Debt Pay Down – $10,000
• Pet Insurance
• Legal Resources Plan
• Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.

Keywords

• #LI-AR2
• Physician Advisor
• Physician Executive
• Medical Director
• Utilization Management
• Utilization Review
• Medical Necessity Review
• Clinical Documentation Integrity (CDI)
• Denials Management
• Appeals Management
• Peer-to-Peer Reviews
• Revenue Cycle
• Case Management
• Care Management
• Hospital Medicine
• Internal Medicine
• Family Medicine
• Emergency Medicine
• Physician Leadership
• Healthcare Quality
• CMS Regulations
• InterQual
• MCG
• DRG
• Hospital Operations
• Medical Staff Engagement
• Healthcare Compliance
• Value‑Based Care
• Clinical Excellence
• Physician Engagement
• Virginia Beach
• Virginia
• Sentara Health
• Hospital Leadership
• Clinical Operations
• Healthcare Administration

About Sentara Virginia Beach General Hospital

Sentara Virginia Beach General Hospital, located in Virginia Beach, VA, is home to the region’s only Level III Trauma Center. Our 273-bed facility has a long history of commitment to our communities of Virginia Beach, Eastern Shore, and Northeastern North Carolina, offering specialized tertiary services as well as many advanced clinical services. We are located just 15 minutes from VA Beach Town Center and just a few minutes to the Oceanfront. As a recognized accredited Primary Stroke Center, and Magnet hospital for nursing excellence, our hospital specializes in heart, vascular, neuroscience, neurosurgery, orthopedics and spine care, cancer care, advanced imaging, and behavioral health.

Sentara Health

Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves. In support of our mission “to improve health every day,” this is a tobacco‑free environment.

For positions that are available as remote work, Sentara Health employs associates in the following states: Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.

Sentara Health is a Virginia and Northeastern North Carolina based not‑for‑profit integrated healthcare provider that has been in business for over 131 years. Offering hundreds of sites of care including 12 hospitals, PACE, home health, hospice, medical groups, imaging services, therapy, outpatient surgery centers, and an 858,000 member health plan. The people of the communities that we serve have nominated Sentara “Employer of Choice” for over ten years. U.S. News and World Report has recognized Sentara as having the Best Hospitals for 15+ years. Sentara offers professional development and a continued employment philosophy!