Physician Advisor (Per Diem) Clinical Resource Management
Wethersfield, CT - USA
Job Summary
At Hartford HealthCare every moment matters. More than 40000 colleagues come to work each day united by a shared purpose: delivering exceptional care advancing innovation and improving the health of the communities we serve.
As Connecticuts most comprehensive integrated health system Hartford HealthCare includes eight acute care hospitals a large multispecialty physician organization behavioral health services rehabilitation home care senior services and an extensive network of ambulatory locations throughout the state. Our physician-led organization is committed to collaboration clinical excellence and creating an environment where providers can thrive.
We invite you to join our team as a Per Diem Physician Advisor with Integrated Care Partners (ICP).
Integrated Care Partners (ICP) is Hartford HealthCares physician-led clinically integrated network dedicated to improving quality enhancing the patient experience and delivering high-value care. Through collaboration across the continuum of care ICP supports physicians in providing exceptional evidence-based care while promoting responsible stewardship of healthcare resources.
The Physician Advisor serves as an integral member of the Clinical Resource Management team partnering closely with Clinical Resource Management nurses attending physicians and hospital leadership to ensure the appropriate utilization of healthcare resources while maintaining the highest standards of patient care.
This role provides physician leadership in utilization management level-of-care determinations regulatory compliance and payer interactions helping to ensure that patients receive the right care at the right time in the most appropriate setting.
- 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.
As a physician with Hartford HealthCare you will join a nationally recognized physician-led organization committed to clinical excellence innovation and collaboration. You will work alongside exceptional colleagues while helping shape the delivery of high-quality patient-centered care across Connecticuts largest integrated healthcare network.
For additional information or a confidential conversation please contact:
Education: Doctor of Medicine or Doctor of Osteopathic Medicine
Experience: Three to five years of acute experience. Five years of relevant experience acute care or managed care is preferred.
Licensure Certification Registration: Valid State of CT Physician License
Knowledge Skills and Ability Requirements:
- 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
Required Experience:
Unclear Seniority