S

Sentara Health

Nonprofit integrated health system and insurer

Regional Physician Advisor - Eastern/Peninsula, Coastal Virginia Near the Beach

Medical, Clinical & VeterinaryConfirmed live in the last 24 hours
Full-timeWilliamsburg, VA, USA

About the Job

Requirements

  • Completion of a Medical Doctorate or Doctor of Osteopathy degree from an accredited medical school.
  • Completion of an accredited residency training program.
  • At least 5 years of clinical experience; hospital clinical experience is strongly preferred.
  • At least 2 years of physician advisory experience is strongly preferred.
  • An active and unrestricted Virginia medical license.
  • Board certification in a specialty at the time of hire.
  • A thorough understanding of CMS regulatory guidance and requirements related to utilization review and site-of-service decisions, either already possessed or acquired.
  • 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 the ability to apply professional judgment and patient-specific variables as necessary or justifiable.
  • Familiarity with hospital organization and case management operations.
  • Ability to present information effectively, both formally and informally.
  • Strong written and verbal communication skills.
  • Strong organizational and analytical skills and the ability to set and manage priorities.
  • Flexibility, teamwork, and a collaborative leadership style.
  • Strong technical and computer skills and working knowledge of the system’s EMR.
  • Ability to provide a consistent on-site presence at assigned sites.

Responsibilities

  • Support the Clinical Revenue Cycle’s Utilization Review and Denials/Appeals processes to determine and secure appropriate level-of-care assignments and ensure compliant billing.
  • Assist with denials management and support documentation integrity as it relates to accurate coding capture.
  • Interface with hospital and medical staff leadership, facilitate communication between Revenue Cycle leadership and processes and hospital facilities, and champion processes and initiatives.
  • Assist with formal and informal education of medical staff at Sentara hospital facilities.
  • Support and meet the Clinical Revenue Cycle’s organizational goals and objectives for effective and efficient utilization of health care services.

Desired Qualifications

  • Hospital clinical experience is strongly preferred.
  • At least 2 years of physician advisory experience is strongly preferred.

About the Company

Sentara Health

Nonprofit integrated health system and insurer

Sentara Health operates a nonprofit, integrated health system across Virginia and North Carolina, running hospitals, urgent care, imaging, and primary care alongside its own health insurance plans. Services span virtual care, cancer and heart care, orthopedics, maternity, and home-based primary care for high-need patients. What sets Sentara apart is pairing hospital and physician care with its own health plans, coordinating coverage and treatment under one system. The goal is to improve health every day so people can keep doing what they love.

Company size
10,001+
Company stage
Not listed
Total funding
Not listed
Headquarters
Norfolk, VA
Founded
Not listed

Recently Posted Jobs

Explore more opportunities at Sentara Health

See more jobs