Physician Advisor Clin Res Mgm / Clinical Resource Management - Hartford Healthcare (HHC)

Exciting Opportunity for Physician Advisor Clinical Resource Management

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 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.

 Department Description:

The Hartford Healthcare CRM, UM, Appeals and Denials team, is a robust, physician-led Physician Advisor program, that prides itself on providing extensive reviews of level of care, peer to peer, appeals as well as performing interdisciplinary rounds through the system. This program covers 7 hospitals and works closely with CRM nurses and medical staff, to ensure compliance with CMS and appropriate use of hospital resources, while also ensuring quality for patients. The physician advisors also contribute to guiding and improving documentation in real-time. The team has ongoing processes for education that involve UM as well as CDI.

Position Summary:

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.

Position Responsibilities:

·        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 of 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.

·        Communicate directly with the attending physicians to guide documentation to reflect severity of illness and intensity of service.

·        Direct interdisciplinary rounds daily.

·        Other additional duties as needed.

Reports To: Associate Medical Director of Clinical Resource Management, Utilization Management and Appeals and Denials