Part-Time Clinical Quality Specialist

About SonderMind

SonderMind is dedicated to providing a personalized, connected, and effective mental health platform, supporting well-being at all life stages. Their services include therapy, medication management, meditation, and mindfulness practices, enhanced by digital tools and research for improved care and thriving clinical practices. Combining technology with human connection, they aim to deliver comprehensive mental health solutions. The company emphasizes the use of modern AI productivity tools like ChatGPT, Gemini, Claude, and GitHub Copilot to enhance workflows and adapt continuously.

Role Overview

The Part-Time Clinical Quality Specialist safeguards clinical care quality and integrity in the organization by focusing on utilization management, payor audits, and clinical quality assurance. The role involves ensuring medical necessity, accurate documentation, and adherence to evidence-based standards and payor requirements. This position plays a foundational role in supporting providers and ensuring compliant clinical operations, serving as a liaison among clinical care, payors, and internal quality teams. The position is part-time, with up to 30 hours weekly, onsite in Boston, MA.

Key Responsibilities

• Perform prospective, concurrent, and retrospective reviews assessing medical necessity, treatment suitability, and appropriate care levels.
• Utilize evidence-based utilization management criteria to evaluate clinical records and facilitate authorization and appeals.
• Track care intensity and usage trends to spot outliers and support targeted provider interventions.
• Collaborate with health plans on external utilization review requests and coordinate peer-to-peer review processes.
• Address and remediate provider concerns from utilization management findings, client complaints, or external sources.
• Monitor adverse clinical events and implement early risk mitigation with cross-functional teams.
• Support initiatives focused on measurement-based care and enhance clinical outcomes for the provider network.
• Maintain utilization metric tracking, case outcome reviews, and volume analysis to guide quality improvements.
• Identify trends and operational gaps, advising leadership and contributing to ongoing policy and workflow enhancements.

Success Criteria

• Utilization reviews conducted with accuracy, timeliness, and compliance.
• Effective translation of utilization findings into measurable provider improvement plans.
• Autonomous case management with thorough documentation and sound clinical judgment.
• Trusted collaboration with cross-functional partners on utilization and quality topics.
• Maintaining positive provider relationships throughout remediation.
• Proactively identifying systemic trends and recommending enhancements to leadership.

Candidate Profile

• Master's degree in a mental health-related discipline.
• Active and current clinical license such as LMFT, LPC, LCSW, LMHC, or equivalent in good standing.
• Experience in utilization management, clinical audits, or medical necessity reviews, particularly in behavioral health or payor environments.
• Well-versed in payor criteria, medical necessity rules, and level-of-care standards.
• Strong clinical judgment with experience managing escalations, adverse incidents, or quality investigations.
• Proficient in creating clear, defensible clinical documentation.
• Capable of effective multidisciplinary collaboration.
• Dedicated to supporting providers and driving quality management.
• Comfortable using clinical technology platforms for documentation, case tracking, and data analysis.

Compensation and Schedule

The role offers hourly compensation ranging from $40 to $42 for up to 30 hours per week. The recruitment will remain open until the position is filled.

Equal Opportunity Statement

The employer is committed to equal employment opportunities without discrimination based on race, sex, gender identity, pregnancy, religion, veteran status, age, disability, sexual orientation, or any legally protected characteristic.