Physician Advisor - Sentara Obici Hospital

Suffolk, VA – First shift (Days)

About the role

The Physician Advisor conducts timely and compliant medical necessity reviews and assists with denials management (facilitating and completing peer-to-peer discussions, writing appeal letters) in support of the centralized system Utilization Review (UR) process for Sentara hospital facilities. The Physician Advisor ensures compliant hospital status/billing for patients and strengthens relationships between Clinical Revenue Cycle, UR, hospital leadership, medical staff, and hospital ICM. This role involves direct interaction with medical staff, providing concurrent communication and education to attending physicians regarding recommended changes in hospital status, regulatory requirements, and documentation integrity to support medical necessity. Due to the collaborative nature of this role, an active and unrestricted Virginia medical license and board-certified status at the time of hire are required, along with superb interpersonal and communication skills. On-site (in-person) presence is integral, with potential coverage at additional sites, including occasional in-person responsibilities. The position reports to the Director of Regional Physician Advisors to Clinical Revenue Cycle.

Responsibilities

• Perform timely and compliant medical necessity reviews, providing clear documentation of pertinent case details to satisfy regulatory requirements and directly communicating necessary changes.
• Facilitate denials management through review of selected cases, conducting peer-to-peer discussions with third-party payers as appropriate, and assisting with appeals letters.
• Work closely with hospital leadership, medical staff, and hospital ICM leaders to support system CPIs and initiatives.
• Attend and participate in Hospital UM committees at designated sites.
• Complete training and continuing education as deemed necessary.
• Attend and participate in educational presentations to medical staff, administration, leadership, and peers.
• Perform additional functions as deemed appropriate and warranted.

Requirements

• Completion of Medical Doctorate or Doctor of Osteopathy 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 required at time of hire (Required).
• Minimum of 3 years of clinical experience; hospital clinical experience preferred.
• Working knowledge of CMS regulatory guidance and requirements as they pertain to UR and site-of-service decisions (Required).
• Working knowledge of clinical documentation integrity, hospital billing and coding processes, case mix index, and DRG assignments (Required).
• Familiarity with standard published leveling criteria such as MCG/Interqual and ability to apply professional judgment and patient-specific variables (Required).
• Familiarity with hospital organization and case management operations (Required).
• Excellent customer service and interpersonal skills (Required).
• Ability to effectively present information, both formal and informal (Required).
• Superb written and verbal communication skills (Required).
• Ability to set and manage priorities (Required).
• Demonstrated flexibility, teamwork, and collaborative leadership style (Required).
• Strong technical/computer skills and working knowledge of the system’s EMR (Required).

Benefits

• Medical, Dental, and Vision plans.
• Adoption, Fertility, and Surrogacy Reimbursement up to $10,000.
• 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 – $5,250/year and discounted educational opportunities through Guild Education.
• Student Debt Pay Down – $10,000 reimbursement for certifications and free access to complete CEUs and professional development.
• Pet Insurance.
• Legal Resources Plan.
• Opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria are met.

About the facility

Sentara Obici Hospital, a 175-bed state-of-the-art facility located on Godwin Boulevard in Suffolk, VA, provides high-quality, patient-centered care. As a recognized accredited Primary Stroke Center and Magnet hospital for nursing excellence, it specializes in orthopedic and spine, heart and vascular, advanced imaging, gynecological and comprehensive breast services, behavioral health, maternity, weight loss surgery, and a heartburn treatment center.