Hospitalist Physician

Location:
Wethersfield, CT
Wethersfield is a charming historic town in central Connecticut offering a wonderful blend of New England character, vibrant community life, and exceptional convenience, with easy access to both Boston and New York City. Residents enjoy outstanding schools, beautiful shoreline destinations, and all the cultural and recreational amenities that Connecticut has to offer.
Facility:
This opportunity is with one of the nation's most integrated and comprehensive healthcare systems, serving patients at more than 500 locations, including eight acute care hospitals, a large multispecialty physician group, behavioral health services, rehabilitation, home care, senior services, and an extensive network of ambulatory sites. The organization is physician-led and nationally recognized for its commitment to innovation, collaboration, education, and excellence in healthcare delivery.
Opportunity:
Physician - Clinical Resource Management Physician Advisor
Job Details:

• Full-time Clinical Resource Management Physician Advisor role reporting to the Associate Medical Director of Clinical Resource Management
• 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
• MD or DO degree required
• Minimum 5 years of acute care clinical experience required (hospital-based)
• Minimum 3 years of prior physician advisor experience or utilization management/managed care experience required
• Unrestricted Connecticut medical license required or eligibility to obtain one
• Strong clinical judgment, decision-making skills, and excellent communication and collaboration abilities required
• Knowledge of utilization management principles, medical necessity criteria, CMS regulations, and commercial payer requirements

Compensation:
Employed salary with benefits.