Physician Advisor Clin Res Mgm / Clinical Resource Management

Hartford Healthcare•Wethersfield, CT

4d•Hybrid

About The Position

Clinical Resource Management Physician Advisor (Full-Time) At Hartford HealthCare in Connecticut Every day, more than 40,000 Hartford HealthCare colleagues come to work united by one shared purpose: knowing every moment matters. As Connecticut's most comprehensive, physician-led healthcare network, we are transforming the delivery of care through innovation, collaboration, education, and excellence. We invite you to join a nationally recognized health system where physicians are empowered to lead, collaborate, and make a meaningful impact on patient care across the continuum. About Hartford HealthCare Hartford HealthCare is one of the nation's most integrated healthcare systems, serving patients at more than 500 locations across Connecticut, including eight acute care hospitals, a large multispecialty physician group, behavioral health services, rehabilitation, home care, senior services, and an extensive network of ambulatory sites. The Clinical Resource Management team plays a vital role in ensuring patients receive the right care, at the right time, in the most appropriate setting while maintaining exceptional clinical outcomes and regulatory excellence. 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. This physician leader serves as a clinical resource for utilization management, level of care determinations, regulatory compliance, and physician education. The ideal candidate combines strong clinical judgment with excellent communication and collaboration skills to help optimize patient outcomes, improve operational efficiency, and support fiscal stewardship across the health system.

Requirements

Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO)
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.
Unrestricted Connecticut medical license (or eligibility to obtain one).
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.

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.