• William Backus Hospital
  • $92,060.00 -43,260.00/year*
  • Wethersfield , CT
  • Healthcare - Allied Health
  • Full-Time
  • 14 Bermuda Rd

Work where every moment matters.

Every day, almost 20,000 Hartford HealthCare employees 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.

Department Description:

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.

Position Summary:

The Medical Director of Clinical Resource Management is an integral member of the HHC Care Management Executive Leadership Team. The Medical Director works in concert with the System Director of Clinical Resource Management on developing, directing, and monitoring the utilization management functions for HHC which ensure that the resources expended to care for our patients are appropriate to the clinical needs of the patient and are being delivered in the least invasive, least restrictive and least costly environment. The Medical Director of Clinical Resource Management ensures the highest quality patient care while maintaining fiscal stewardship for HHC as well as regulatory compliance.

Position Responsibilities:

* Build, develop and provide day to day oversight of Physician Advisor team and operations across the system including coverage, training and performance management.
* Act as Physician Advisor and review cases for level of care determinations, appropriate utilization of resources and intervenes with payers for peer to peer negotiation and appeal/denial support.
* Establish and monitor performance indicators, goals and objectives that are consistent with Revenue Cycle and HHC strategic objectives, mission, vision and values.
* Monitor utilization trends and develop relevant action plans to address identified issues.
* Ensure adequate and appropriate education to all physicians regarding relevant resource utilization standards and trends.
* Develop, oversee and facilitate a system wide Utilization Management Plan, to include acting as Chair of the Utilization Management Committee, which meets regulatory compliance standards and evaluate annually.
* Develop and maintain expertise of regulatory guidelines regarding utilization review activities including revisions as they occur and develop action plans to ensure HHC compliance as well as successful integration of any changes.
* Maintain awareness and understanding of payer requirements and opportunities and incorporate into utilization review strategy and focus areas, attend payer Joint Operating Committee Meetings when necessary.
* Ensure compliance with CarePartners of Connecticut care model components specific to utilization review.
* Other duties as assigned.

Reports To: Medical Director ICP; dotted line to Administrative Partner - System Director of Clinical Resource Management

Direct Reports: 10

Education: Doctor of Medicine or Doctor of Osteopathic Medicine

Experience: Three to five years of acute care and/or managed care.

Licensure, Certification, Registration: Valid State of CT Physician License is required. ABQAURP (American Board of Quality Assurance and Utilization Review Physicians) HCQM (Healthcare Quality and Management) Board Certification with Physician Advisor Sub Specialty Certification is preferred.

Knowledge, Skills and Ability Requirements:

* Process redesign and change management
* Able to lead, influence and negotiate
* Executive presentation and communication skills
* Ability to understand and interpret patient data, finance and utilization reports

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.

Associated topics: biopharma, cytometry, immuno oncology, industrial hygienist, nutrition, pharmacometrics, pharmacy, protein, trauma, vaccine

* The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.

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