Clinical Quality Specialist

About the Company

SonderMind is focused on making mental health care more connected, personalized, and effective for people at every stage of life. Its offerings span therapy, medication management, meditation, and mindfulness support. The organization combines technology with human connection so clinicians can deliver stronger outcomes and build successful practices.

Team members are also expected to use modern AI tools in their day-to-day work and stay adaptable as new tools become available. Comfort with relevant AI platforms such as Gemini, ChatGPT, Claude, GitHub Copilot, or similar productivity tools is considered an essential part of success in this environment.

Role Overview

The Clinical Quality Specialist, Utilization Management role is responsible for protecting clinical quality across the organization with a particular focus on utilization management, payer-facing clinical audits, and quality assurance. The position helps ensure that care is medically justified, well documented, and aligned with evidence-based standards and payer expectations, while also supporting providers and maintaining compliant operations.

This is a collaborative position that blends clinical judgment with utilization review and audit preparedness. The specialist acts as a connector between care delivery, payer requirements, and internal quality standards.

Key Responsibilities

• Perform prospective, concurrent, and retrospective utilization reviews to evaluate medical necessity, treatment fit, and level of care.
• Use evidence-based utilization management criteria to assess documentation and support authorization and appeal activities.
• Observe care intensity and utilization patterns to spot outliers and guide focused provider support.
• Work with health plans to manage external utilization review requests and coordinate peer-to-peer reviews.
• Address provider issues that arise from utilization findings, client complaints, or outside reports, and help resolve them.
• Monitor adverse clinical events and partner with other teams on early risk reduction efforts.
• Support measurement-based care programs and look for ways to improve clinical outcomes across the provider network.
• Track utilization data, review activity, and case outcomes to support quality improvement work.
• Escalate recurring trends and process gaps to leadership and help refine utilization management policies and workflows.

Success Indicators

• Reviews are completed accurately, promptly, and in line with payer and regulatory expectations.
• Utilization findings lead to practical provider support plans and visible improvements in care appropriateness.
• Cases are handled independently with strong clinical reasoning, detailed documentation, and limited supervision.
• Cross-functional partners view you as a reliable, solutions-oriented resource for utilization and quality matters.
• Provider relationships stay constructive and trust-based, including during remediation discussions.
• You identify broader utilization patterns early and recommend meaningful improvements to leadership.

Candidate Profile

The ideal candidate holds a master’s degree in a mental health field and has an active, unencumbered clinical license such as LMFT, LPC, LCSW, LMHC, or an equivalent credential. Prior experience in utilization management, utilization review, medical necessity review, or clinical auditing is expected, preferably in behavioral health or within a payer or health plan setting.

Strong familiarity with payer rules, medical necessity standards, and level-of-care guidance is important, along with sound clinical judgment and experience handling escalations, adverse events, or quality investigations. The role also requires the ability to create clear, accurate, and defensible documentation, collaborate across teams, and use clinical systems for documentation, case tracking, and data analysis.

Benefits

• Generous paid time off, including at least three weeks away from work each year.
• Holiday schedule aligned with standard U.S. holidays.
• Free therapy coverage for employees enrolled in a qualifying medical plan.
• Medical, dental, and vision plans, including HSA options with a $1,100 company contribution and FSA options.
• Employer-paid short-term disability, long-term disability, life insurance, and AD&D, plus salary-gap coverage for up to seven weeks of short-term disability leave after the waiting period.
• Eight weeks of paid parental leave, with the possibility of 8–16 weeks if short-term disability also applies.
• 401(k) plan with a 100% match on contributions up to 4% of base salary, vested immediately.
• Annual company gathering with colleagues from across the country.
• Company shutdown between Christmas and New Year’s.
• Additional support such as supplemental life insurance, pet insurance, commuter benefits, and more.

Application Details

This role is part of an ongoing hiring process and will remain open until a suitable candidate is selected.

Equal Opportunity

SonderMind follows an equal opportunity employment approach and does not make hiring decisions based on race, color, creed, sex, gender, gender identity or expression, pregnancy, childbirth or related medical conditions, religion, veteran or military status, marital status, registered domestic partner status, age, national origin or ancestry, physical or mental disability, medical condition including genetic information or characteristics, sexual orientation, or any other status protected by applicable law.