Physician Advisor

Hartford HealthCare is seeking a Per Diem Physician Advisor to join their Clinical Resource Management team in Wethersfield, Connecticut. In this role, you will partner closely with clinical resource management nurses, attending physicians, and hospital leadership to ensure appropriate healthcare resource utilization and regulatory compliance. You will provide essential physician leadership in level-of-care determinations, peer-to-peer discussions, and denial management. Join Connecticut's most comprehensive integrated health system and help drive clinical excellence across our network.

Practice Info

• Clinical Resource Management team setting
• Part of Hartford HealthCare's integrated health system including eight acute care hospitals and an extensive network of ambulatory locations

Shift & Schedule

• Per diem shifts

Responsibilities

• Perform second-level physician reviews for level-of-care determinations and appropriate utilization of healthcare resources.
• Respond promptly to requests from Clinical Resource Management nurses for physician review.
• Collaborate with attending physicians to resolve level-of-care questions and address opportunities for appropriate resource utilization.
• Conduct peer-to-peer discussions with insurance payers and provide support for appeals and denial management.
• Maintain current knowledge of regulatory requirements, utilization management standards, and payer guidelines.
• Educate physician colleagues on utilization management best practices and evolving regulatory trends.
• Meet established Physician Advisor coverage requirements for assigned per diem shifts.
• Participate in quality improvement initiatives and perform other duties as assigned.

Qualifications

• Doctor of Medicine or Doctor of Osteopathic Medicine
• Three to five years of acute experience
• Five years of relevant experience, acute care or managed care is preferred
• Valid State of CT Physician License
• Able to influence, negotiate and educate
• Ability to understand and interpret patient data, finance and utilization reports
• Understanding of government and payer coverage criteria and regulatory requirements