Physician Advisor: Utilization & Denials (On-Site)

Sentara-9; Suffolk (VA); On-site; USD 180,000 - 230,000; Full time

Benefits offered by this job

Medical, Dental, Vision plans

401k/403B with Employer Match

Paid Time Off

Job summary

Sentara Obici Hospital in Suffolk, VA seeks a Physician Advisor to lead timely medical necessity reviews, assist with denials management, and support compliant billing through the central Utilization Review process.

The on-site, full-time role partners with physicians, ICM, and hospital leadership to strengthen documentation integrity, CMS regulatory adherence, and department education; a Virginia license, board certification, and 3+ years hospital experience are required.

Qualifications

• MD/DO degree with residency
• Virginia medical license active
• Board certification in specialty at hire
• Experience in utilization review and denials management

Responsibilities

• Perform timely medical necessity reviews and document regulatory status determinations.
• Facilitate denials management through case reviews and peer-to-peer discussions.
• Collaborate with hospital leadership, medical staff, and ICM to support system initiatives.
• Attend Hospital Utilization Management Committees and related meetings.
• Educate physicians and staff on utilization review and documentation integrity

Skills

Regulatory knowledge

Presentation & education

Communication

Collaboration

Education

MD/DO medical degree

Virginia medical license

Board certification

Residency training

Tools

EMR systems

InterQual

MCG

Job description

Sentara Obici Hospital in Suffolk, VA seeks a Physician Advisor to lead timely medical necessity reviews, assist with denials management, and support compliant billing through the central Utilization Review process.

The on-site, full-time role partners with physicians, ICM, and hospital leadership to strengthen documentation integrity, CMS regulatory adherence, and department education; a Virginia license, board certification, and 3+ years hospital experience are required.