Regional Physician Advisor: Utilization Review & Education

Sentara Health; Norfolk (VA); On-site; USD 200,000 - 250,000; Full time

Job summary

Sentara Healthcare Inc is seeking a qualified individual for the position of Regional Physician Advisor in Norfolk, Virginia. This full-time role involves supporting the Clinical Revenue Cycle’s Utilization Review processes and ensuring compliance in billing.

The ideal candidate will have a medical doctorate, significant clinical experience, and strong interpersonal skills to effectively communicate and educate medical staff.

The position requires on-site presence and offers a unique opportunity to influence healthcare services positively.

Qualifications

• Minimum of 5 years of clinical experience, hospital clinical experience strongly preferred.
• Minimum of 2 years of physician advisory experience strongly preferred.
• Active and unrestricted state Virginia medical license.

Responsibilities

• Support Clinical Revenue Cycle’s Utilization Review and Denials/Appeals processes.
• Facilitate communication between Revenue Cycle leadership and hospital facilities.
• Assist with both formal and informal education of medical staff.

Skills

Customer service

Interpersonal skills

Organizational skills

Analytical skills

Technical skills

Communication skills

Education

Medical doctorate or Doctor of Osteopathy

Completion of accredited residency training program

Tools

EMR systems

Job description

Make a broader impact beyond patient care and help shape healthcare delivery at Sentara Health.

As a Regional 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.

Sentara Health is seeking to hire a qualified individual to join our team as Regional Physician Advisor.

Position Status: Full-time, Day Shift

Position Location: On-site.

Standard Working Hours: 8:00AM to 5:00PM (ET).

Sentara Health is seeking to hire a qualified individual to join our team as Regional Physician Advisor.

Expectations for this Role:

The Regional Physician Advisor supports the Clinical Revenue Cycle’s Utilization Review and Denials/Appeals processes to determine and secure appropriate level of care assignments to ensure compliant billing, assist with denials management, support documentation integrity as it pertains to accurate coding capture. The Regional Physician Advisor interfaces with hospital and medical staff leadership, facilitating communication between Revenue Cycle leadership and processes and the hospital facilities and championing processes and initiatives. The Regional Physician Advisor assists with both formal and informal education of medical staff at Sentara hospital facilities. This role is responsible for supporting and meeting the Clinical Revenue Cycle functions organizational goals and objectives for assuring the effective, efficient utilization of health care services.

Requirements:

Completion of Medical doctorate or Doctor of Osteopathy degree from an accredited medical school
• Completion of an accredited residency training program
• Minimum of 5 years of clinical experience, hospital clinical experience strongly preferred
• Minimum of 2 years of physician advisory experience strongly preferred
• Active and unrestricted state Virginia medical license
• Board certification in specialty required at time of hire
• Posess or acquire a thorough understanding of CMS regulatory guidance and requirements as they pertain to UR and site of service decisions
• Possess a working knowledge of clinical documentation integrity, hospital billing and coding processes and guidelines, case mix index, and DRG assignments.
• Familiarity with standard published leveling criteria such as MCG/Interqual and ability to apply professional judgment and patient specific variables as may be necessary or justifiable.
• Familiarity with (Hospital) organization and case management operations
• Excellent customer service and interpersonal skills.
• Able to effectively present information, both formal and informal
• Superb written and verbal communications skills
• Strong organizational and analytic skills, and ability to set and manage priorities
• Demonstrate flexibility, teamwork, and a collaborative leadership style
• Strong technical/computer skills and working knowledge of the system’s EMR
• Ability to provide a consistent on-site presence at assigned sites

#indeed

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, 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.Sentara offers a comprehensive benefits package, including medical, dental, vision, life and disability insurance; 401(k)/403(b) with employer match; paid time off (vacation, sick time, and holidays); paid parental and military leave; educational assistance or student loan repayment; and voluntary benefits.

Sentara Norfolk General Hospital, located in Norfolk, VA, is a 525-bed tertiary care facility that is home to the only Level I Adult Trauma Center and burn trauma unit in Hampton Roads, and also serves as the primary teaching hospital for Eastern Virginia Medical School. In addition to the high-quality heart program at Sentara Heart Hospital, our facility is home to Nightingale Regional Air Ambulance and several other dedicated facilities and specialized services. As a recognized accredited Comprehensive Stroke Center, and Magnet hospital for nursing excellence, our hospital specializes in heart and vascular, neurosciences, neurosurgery, urology, oncology, spine care, advanced imaging, behavioral health, maternity, and women’s health, including a state-of-the-art neonatal intensive care unit.ed Imaging Center at Sentara Princess Anne Hospital is conveniently located in the heart of Virginia Beach and offers high-speed digital diagnostic equipment that provides faster and more precise results. The center provides one of the region's most advanced imaging technologies interpreted by board certified radiologists specializing in various areas of imaging.