Regional Physician Advisor - Utilization & Quality

Sentara-9; Norfolk (VA); On-site; USD 120,000 - 180,000; Full time

Benefits offered by this job

Medical, Dental, Vision plans

401k/403B with Employer Match

Tuition Assistance

Job summary

Sentara Health is seeking a Regional Physician Advisor to influence patient care quality and ensure compliant billing through Utilization Review and denials management. The role collaborates with hospital leadership, medical staff, and Revenue Cycle teams to improve documentation, case mix, and DRG accuracy.

Requires MD/DO, Virginia license, and 5+ years clinical experience with 2+ years advisory work. On-site position in Norfolk, VA with full-time day shift and comprehensive benefits.

Qualifications

• MD or DO from an accredited medical school.
• Active Virginia medical license.
• Board certification in specialty required at time of hire.
• Minimum 5 years clinical experience; hospital clinical experience preferred.
• Minimum 2 years physician advisory experience preferred.
• Knowledge of CMS regulatory guidance pertaining to Utilization Review and site of service decisions.
• Understanding of clinical documentation integrity, hospital billing and coding processes.
• Familiarity with MCG/InterQual and applying professional judgment.

Responsibilities

• Support Utilization Review and Denials/Appeals processes to ensure appropriate level of care.
• Interface with hospital and medical staff leadership to align Revenue Cycle and hospital processes.
• Educate medical staff at Sentara hospital facilities on UR and documentation standards.
• Assist with on-site processes to improve case mix, DRG assignments, and coding accuracy.
• Provide consistent on-site presence at assigned sites and collaborate with leaders.

Skills

Clinical leadership

CMS guidelines

Communication

Education/teaching

Education

MD/DO

Tools

EMR systems

Coding knowledge

Job description

Sentara Health is seeking a Regional Physician Advisor to influence patient care quality and ensure compliant billing through Utilization Review and denials management. The role collaborates with hospital leadership, medical staff, and Revenue Cycle teams to improve documentation, case mix, and DRG accuracy.

Requires MD/DO, Virginia license, and 5+ years clinical experience with 2+ years advisory work. On-site position in Norfolk, VA with full-time day shift and comprehensive benefits.