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SW
Strive Wellness Center LLC
Behavioral Health Professional
Career Insights for Clinical Auditor / Utilization Reviewer
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Scorecard
Based on Arizona data
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What they do
A Clinical Auditor or Utilization Reviewer reviews the efficiency of healthcare delivery. Individuals tend to have had experience as a registered nurse or other healthcare delivery roles before transferring into this quality review role.
$88,523 / year median in Arizona
-7% projected decline
Job Description
Job Summary The Behavioral Health Professional (BHP) serves as a licensed clinical provider responsible for delivering high-quality behavioral health services while providing clinical oversight in accordance with Arizona Department of Health Services (ADHS), Arizona Health Care Cost Containment System (AHCCCS), applicable state and federal regulations, and organizational policies. The BHP is responsible for conducting behavioral health assessments, developing and reviewing individualized treatment plans, supervising clinical documentation, providing staff training, conducting clinical record reviews, and ensuring services are medically necessary, person-centered, and compliant with regulatory standards. The BHP promotes quality improvement, supports staff development, and collaborates with the multidisciplinary treatment team to ensure safe, effective, and recovery-oriented behavioral health services. Clinical Assessment Complete comprehensive behavioral health assessments and biopsychosocial evaluations. Complete diagnostic assessments within scope of licensure. Evaluate risk factors including suicide, homicide, self-harm, abuse, neglect, and substance use. Determine medical necessity for behavioral health services. Identify client strengths, barriers, support systems, and treatment needs. Recommend the appropriate level of care and referrals when clinically indicated. Update assessments whenever significant clinical changes occur. Treatment Planning Develop individualized, person-centered treatment plans with measurable goals and objectives. Ensure treatment plans address identified behavioral health and substance use needs. Review, approve, and sign treatment plans as required. Update treatment plans according to ADHS, AHCCCS, payer requirements, and organizational policy. Participate in multidisciplinary treatment planning meetings. Monitor progress toward treatment goals and revise plans as clinically indicated. Ensure discharge planning begins at admission and is incorporated throughout treatment. Clinical Oversight The BHP shall serve as the organization's Clinical Oversight designee and is responsible for maintaining the quality and integrity of clinical services.