Physician Advisor - Sentara Virginia Beach General Hospital

Responsibilities

• Perform timely and compliant medical necessity reviews, providing clear documentation of the pertinent details of the case to satisfy regulatory requirements and directly communicating any necessary Facilitate denials management through review of selected cases, conducting peer to peer discussion 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

Qualifications

• Completion of Medical Doctorate or Doctor of Osteopathy degree from an accredited medical school
• Completion of an accredited residency training program
• Active and unrestricted state of Virginia medical license
• Board certification in specialty required at time of hire
• Minimum of 3 years of clinical experience, hospital clinical experience (Preferred)
• Possess or acquire a working knowledge 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 communication skills
• 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