Physician Advisor - Sentara Obici Hospital

City/State

Work Shift

The On-Site Physician Advisor at Sentara Princess Anne 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.

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  Perform timely and compliant medical necessity reviews and provide clear documentation supporting regulatory requirements and status determinations.

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  Facilitate denials management through case reviews, peer-to-peer discussions with payers, and assistance with appeal letter preparation.

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  Collaborate with hospital leadership, medical staff, and ICM leaders to support system initiatives and performance goals.

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  Attend and participate in Hospital Utilization Management (UM) Committees and other designated meetings.

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  Provide education to physicians, leaders, and staff regarding utilization review, documentation integrity, and regulatory requirements.

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  Complete required training and continuing education.

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  Support additional responsibilities as appropriate to departmental and organizational needs.

• 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)

• Active and unrestricted Virginia medical license (Required)

• Board certification in specialty at time of hire (Required)

• 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.

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.

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.