Job Schedule: Full Time Standard Hours: 40 Job Shift: Shift 1 Shift Details: will have varying shifts throughout the week- includes weekends
Work where every moment matters.
Every day, over 30,000 Hartford HealthCare colleagues come to work with one thing in common: Pride in what we do, knowing every moment matters here. We invite you to become part of Connecticut’s most comprehensive healthcare network.
The creation of the HHC System Support Office recognizes the work of a large and growing group of employees whose responsibilities are continually evolving so that we and our departments now work on behalf of the system as a whole, rather than a single member organization. With the creation of our new umbrella organization we now have our own identity with a unique payroll, benefits, performance management system, service recognition programs and other common practices across the system.
Integrated Care Partners (ICP) is a physician-led, clinically integrated health care network whose mission is to assist our members in providing the highest quality care at the most reasonable cost for our patients in the current, rapidly changing medical environment.
The Physician Advisor is an integral member of the Clinical Resource Management Team who partners closely with the Clinical Resource Management Nurse to evaluate the resources expended to care for our patients and ensure they are appropriate to the clinical needs of the patient and are being delivered in the least invasive, least restrictive and least costly environment. The Physician Advisor ensures the highest quality patient care while maintaining fiscal stewardship for HHC as well as regulatory compliance.
Review cases identified in need of second level physician review for level of care determinations and appropriate utilization of resources.
Respond promptly to requests for second level physician review by the Clinical Resource Management Nurse.
Communicate directly with attending physicians on level of care discrepancies, over-utilization and under-utilization or resources to affect resolution.
Intervene as needed with payers for peer to peer negotiation and appeal/denial support.
Develop and maintain expertise of regulatory guidelines regarding utilization review activities and utilization standards and trends.
Provide education to physician colleagues on utilization standards and trends.
Adhere to minimum Physician Advisor shift coverage requirements.
Other duties as assigned.
Reports To: Medical Director of Clinical Resource Management
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
We take great care of careers.
With locations around the state, Hartford HealthCare offers exciting opportunities for career development and growth. Here, you are part of an organization on the cutting edge – helping to bring new technologies, breakthrough treatments and community education to countless men, women and children. We know that a thriving organization starts with thriving employees-- we provide a competitive benefits program designed to ensure work/life balance. Every moment matters. And this is your moment.