Physician Advisor, Clinical Resource Management

Hartford Health Care is seeking a dedicated Clinical Resource Management Physician Advisor to join their collaborative system-wide team in Connecticut. In this role, you will partner closely with nurses, physician colleagues, and leadership to promote appropriate utilization of healthcare resources and support high-quality patient care. You will serve as a vital clinical resource for utilization management, regulatory compliance, and physician education within a nationally recognized health system.

Join Hartford Health Care to make a meaningful impact on patient care and operational excellence while working in a supportive, physician-led environment.

Practice Info

• Clinical Resource Management team within Hartford Health Care system
• System-wide team across Connecticut locations

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.

Compensation

• Competitive compensation

Benefits

• Comprehensive benefits

Shift & Schedule

• Full-Time

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.