Physician Advisor Sentara Virginia Beach General Hospital

City/State

Virginia Beach VA

Work Shift

First (Days)

Overview:

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

As a Physician Advisor youll 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.

The On-Site Physician Advisor at Sentara Virginia Beach General Hospitall 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 Sentaras 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.

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

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

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

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

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

• Complete required training and continuing education.

• 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.

We provide market-competitive compensation packages inclusive of base pay incentives and benefits. The base pay range for full-time employment is $93600.00 - $312000.00 annually. Additional compensation may be available for this role such as shift differentials standby/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 2080 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.

Benefits: Caring For Your Family and Your Career

Medical Dental Vision plans

Adoption Fertility and Surrogacy Reimbursement up to $10000

Paid Time Off and Sick Leave

Paid Parental & Family Caregiver Leave

Emergency Backup Care

Long-Term Short-Term Disability and Critical Illness plans

Life Insurance

401k/403B with Employer Match

Tuition Assistance $5250/year and discounted educational opportunities through Guild Education

Student Debt Pay Down $10000

Pet Insurance
Legal Resources Plan
Colleagues have the opportunity to earn an annual discretionary bonus ifestablished system and employee eligibility criteria is met.

Sentara Virginia Beach General Hospital located in Virginia Beach VA is home to the regions only Level III Trauma Center. Our 273-bed facility has a long history of commitment to our communities of Virginia Beach Eastern Shore and Northeastern North Carolina offering specialized tertiary services as well as many advanced clinical services. We are located just 15 minutes from VA Beach Town Center and just a few minutes to the Oceanfront.

As a recognized accredited Primary Stroke Center and Magnet hospital for nursing excellence our hospital specializes in heart vascular neuroscience neurosurgery orthopedics and spine care cancer care advanced imaging and behavioral health.

Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its close to an almost 30000-member workforce. Diversity inclusion and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.

In support of our mission to improve health every day this is a tobacco-free environment.

For positions that are available as remote work Sentara Health employs associates in the following states:

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.