Physician Advisor: Utilization & Medical Necessity

Sentara-9; Suffolk (VA); On-site; USD 94,000 - 312,000; Full time

Benefits offered by this job

Medical, Dental, Vision

401k with Employer Match

Tuition Assistance

Student Debt Pay Down

Paid Time Off & Sick Leave

Life Insurance

Job summary

Sentara Health seeks a Physician Advisor for Sentara Obici Hospital in Suffolk, VA. This on-site role blends clinical expertise with regulatory compliance, supporting hospital status determinations and denials management within the centralized Utilization Review process.

You will educate physicians and staff, participate in UM committees, and collaborate across Clinical Revenue Cycle, ICM, and hospital leadership to improve care and compliance.

Qualifications

• MD or DO degree from an accredited medical school; board certification in specialty at hire.
• Active Virginia medical license; completion of residency.
• Hospital-based clinical experience preferred; strong regulatory knowledge required.
• Ability to apply clinical judgment in complex cases with standards like InterQual/MCG.

Responsibilities

• Perform timely and compliant medical necessity reviews with clear documentation.
• Facilitate denials management via case reviews and peer‑to‑peer discussions.
• Collaborate with leadership and medical staff on system initiatives and goals.
• Attend UM Committee meetings and provide physician education on requirements.
• Provide ongoing education on utilization review and documentation integrity.

Skills

CMS regulations

Utilization Review

Denials management

Physician education

InterQual/MCG knowledge

EMR systems proficiency

Hospitals operations knowledge

Education

MD/DO

Tools

InterQual

MCG

EMR systems

Job description

Sentara Health seeks a Physician Advisor for Sentara Obici Hospital in Suffolk, VA. This on-site role blends clinical expertise with regulatory compliance, supporting hospital status determinations and denials management within the centralized Utilization Review process.

You will educate physicians and staff, participate in UM committees, and collaborate across Clinical Revenue Cycle, ICM, and hospital leadership to improve care and compliance.