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Job description
Job Title
Clinical Resource Management Physician Advisor
Organization
Hartford HealthCare Corp.
Location
Connecticut-Wethersfield-1290 Silas Deane Hwy Wethrsfld (10181)
Position Summary
Hartford HealthCare is seeking a Clinical Resource Management Physician Advisor to join our collaborative system-wide team. Reporting to the Associate Medical Director of Clinical Resource Management, the Physician Advisor partners closely with Clinical Resource Management nurses, physician colleagues, hospital leadership, and payer organizations to promote appropriate utilization of healthcare resources while supporting high-quality, patient-centered care.
Primary Responsibilities
Provide second-level physician review for level of care determinations and appropriate utilization of healthcare resources. Collaborate with Clinical Resource Management nurses to ensure patients receive care in the most clinically appropriate setting. Communicate directly with attending physicians regarding level of care determinations, documentation opportunities, and resource utilization. Conduct peer-to-peer discussions with payer medical directors to support authorization requests, appeals, and denial management. Maintain expertise in CMS regulations, commercial payer guidelines, utilization management standards, and regulatory requirements. Educate physicians and clinical teams on utilization management best practices, documentation, and evolving regulatory standards. Participate in quality improvement initiatives that enhance patient care, operational performance, and regulatory compliance. Meet established Physician Advisor coverage expectations and participate in additional projects as assigned.
Qualifications
Education: Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) Experience: Minimum 5 years of acute care clinical experience required (Hospital based) 3 years or more of prior physician advisor experience or utilization management/managed care experience required. Licensure: Unrestricted Connecticut medical license (or eligibility to obtain one). Knowledge, Skills & Abilities: Strong clinical judgment and decision-making skills. Excellent communication, collaboration, and relationship-building abilities. Ability to educate and effectively communicate with physician and APP colleagues and to guide appropriate documentation and level of care decisions. Ability to also communicate effectively with payor organizations. Knowledge of utilization management principles, medical necessity criteria, CMS regulations, and commercial payer requirements. Ability to interpret clinical, financial, and utilization data to support evidence-based decision making. Commitment to quality improvement, patient-centered care, and continuous process improvement.
Why Hartford HealthCare?
At Hartford HealthCare, physicians benefit from: A physician-led, collaborative culture. Opportunities to lead system-wide initiatives that improve patient care and operational excellence. Access to robust physician leadership and professional development programs. Competitive compensation and comprehensive benefits. A commitment to physician wellness and work-life balance. The opportunity to practice within one of New England's premier integrated healthcare systems while enjoying everything Connecticut has to offer—including outstanding schools, vibrant communities, beautiful shoreline, and convenient access to both Boston and New York City.
Worksite address
rocky hill, CT, 06067, US
Who can apply
Review the original listing for work authorization, qualifications and employer requirements.