This role centers on physician-level utilization management, level-of-care review, and regulatory oversight for hospitalized patients. The physician advisor works with nurses, attending physicians, hospital leaders, and payer medical directors to support appropriate care placement, documentation, and authorization decisions. It is a collaborative, system-level position that also includes physician education and quality improvement work.
Key Responsibilities
- Provide second-level physician review for level-of-care determinations and utilization decisions.
- Collaborate with Clinical Resource Management nurses to support care in the most appropriate clinical setting.
- Communicate with attending physicians about documentation opportunities, medical necessity, and resource use.
- Conduct peer-to-peer discussions with payer medical directors for authorizations, appeals, and denial management.
- Maintain expertise in CMS regulations, commercial payer guidelines, and utilization management standards.
- Educate physicians and clinical teams on utilization management best practices and regulatory requirements.
- Participate in quality improvement initiatives that support patient care, operational performance, and compliance.
- Meet physician advisor coverage expectations and contribute to assigned projects.
Required
- Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) degree.
- At least 5 years of acute care hospital-based clinical experience.
- At least 3 years of physician advisor experience or utilization management/managed care experience.
- Unrestricted Connecticut medical license or eligibility to obtain one.
Preferred
- Prior physician advisor experience in a hospital or health system setting.
- Experience working with utilization management or managed care processes.
Benefits & Perks
- Physician-led, collaborative culture.
- Opportunity to lead system-wide initiatives.
- Access to physician leadership and professional development programs.
- Competitive compensation and comprehensive benefits.
- Support for physician wellness and work-life balance.
- Salaried position.