Open to opportunities

Jennifer Phillips

@jenniferphillips

Compliance, Quality & Utilization Review Leader | LCSW, LICSW | Behavioral Health | Medical Necessity, Audit Readiness, Regulatory Training | Remote

United States

Message

What I'm looking for

I seek remote or hybrid roles where I can lead utilization management, clinical quality, and compliance programs, drive audit readiness, mentor teams, and influence strategic, population-health focused outcomes.

I am a licensed clinical social worker with over 10 years of experience working in utilization review, clinical quality, compliance, and healthcare operations across federal, FQHC, tribal health, and telehealth systems.

My work has focused on medical necessity review, level-of-care determination, documentation quality, audit readiness, and regulatory compliance, including CARF and Joint Commission standards. I have led internal chart audits, developed policies and workflows, trained clinical teams on documentation and compliance requirements, and partnered with leadership to reduce risk and improve care delivery.

While my background is clinical, my professional focus is non-clinical and systems-based. I specialize in translating complex regulatory, payer, and accreditation requirements into practical processes that support appropriate utilization, consistent documentation, and high-quality, compliant care.

I am particularly interested in remote roles involving:

• Utilization Review / Utilization Management

• Clinical Quality & Documentation Integrity

• Compliance Program Support & Regulatory Training

• Healthcare Operations & Risk Management

I am licensed in Alabama, Arizona, Florida, and Utah and work effectively in remote, cross-functional environments.

Open to remote opportunities in utilization review, quality, and compliance.

Experience

Work history, roles, and key accomplishments

Current

Staff Therapist

Current

Talkiatry

Mar 2025 - Present (10 months)

Deliver high-volume telehealth care applying medical necessity criteria and maintaining audit-ready documentation while collaborating in interdisciplinary teams to support care coordination and utilization-aligned treatment.

Telehealth Medical Necessity Criteria Clinical Documentation Care Coordination Utilization Review

Current

Therapist / Practice Owner

Current

Tucson Counseling PLLC

Oct 2019 - Present (6 years 3 months)

Manage a private practice focusing on comprehensive clinical assessments, audit-ready EHR documentation, and compliance oversight to ensure appropriate utilization and treatment outcomes.

Clinical Assessment EHR Treatment Planning SOPs

Current

Compliance Consultant

Current

Independent Consultant

Apr 2016 - Present (9 years 9 months)

Lead strategic and operational initiatives supporting utilization management, accreditation readiness, and clinical quality across healthcare organizations; conduct internal audits and develop policies and training that improve documentation integrity and regulatory compliance.

Utilization Management Clinical Quality Accreditation (CARF Joint Commission)Risk Mitigation

Therapist

Neighborhood Outreach Access to Health

Sep 2022 - Mar 2025 (2 years 6 months)

Conduct assessments and treatment planning to support level-of-care decisions, maintain compliant documentation, and participate in quality improvement and utilization monitoring to align services with regulatory requirements.

Assessments Treatment Planning Documentation Requirements Quality Improvement Peer Review Reporting

Director of Behavioral Health

Desert Senita Community Health Center

Jul 2021 - Sep 2022 (1 year 2 months)

Led utilization management, clinical quality, and compliance across behavioral health services; conducted audits, developed SOPs for accreditation readiness, and trained staff to improve documentation and reduce utilization risks.

Utilization Management Clinical Quality Policy Development Staff Training Risk Mitigation

Behavioral Medicine Therapist

Tohono O'odham Nation Health Care

Apr 2018 - Aug 2021 (3 years 4 months)

Provided utilization-focused behavioral health within integrated primary care, performing assessments to determine level of care, ensuring documentation met payer and accreditation standards, and participating in QI initiatives to improve access and continuity.

Assessments Care Coordination Quality Improvement Utilization Review Interdisciplinary Collaboration

Director of Social Work

Tohono O'odham Nation Health Care

Feb 2019 - Sep 2019 (7 months)

Directed clinical quality and utilization oversight for social work and behavioral health services, standardized documentation templates to Joint Commission standards, and advised leadership on utilization and operational improvements.

Clinical Leadership Joint Commission Staff Training

Senior Social Worker

U.S. Department of Veterans Affairs

Apr 2017 - Apr 2018 (1 year)

Led utilization-focused chart reviews and internal audits aligned with CARF and Joint Commission standards, identified utilization risks, and developed documentation templates and training to improve audit readiness.

Chart Reviews Internal Audit CARF Joint Commission Compliance Training

Clinical Social Worker

U.S. Department of Veterans Affairs

Jun 2013 - Jun 2017 (4 years)

Conducted biopsychosocial assessments and medical necessity evaluations to support appropriate service utilization, coordinated transitions of care, and reviewed documentation for regulatory compliance.

Biopsychosocial Assessments Transition Of Care Documentation Review Regulatory Compliance