Physician Advisor Per Diem - Clinical Resource Management

Hartford Healthcare • Wethersfield, CT

9d

About The Position

The Physician Advisor is an integral member of the Clinical Resource Management team, partnering with Clinical Resource Management nurses, attending physicians, and hospital leadership to ensure appropriate use of healthcare resources while maintaining high standards of patient care. The role provides physician leadership in utilization management, level-of-care determinations, regulatory compliance, and payer interactions, helping ensure patients receive appropriate care in the right setting and at the right time.

This is a per diem position with assigned coverage shifts. The Physician Advisor also participates in quality improvement initiatives and performs other duties as assigned.

Requirements

• Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO).
• Three to five years of acute experience.
• Valid State of Connecticut physician license.
• Ability 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.

Nice To Haves

• Five years of relevant experience in acute care or managed care is preferred.

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 support 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.

What This Job Offers

• Career Level: Senior
• Education Level: Ph.D. or professional degree