Physician Advisor, Clinical Resource Management

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 This is a salaried position. Actual pay will be determined based on qualifications, location, internal equity, and other factors that may include hire bonuses, incentive pay plans, loan repayment, administrative stipends, or relocation.

Benefits: Competitive compensation and comprehensive benefits.

Qualifications: 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).