Clinical Quality Specialist

About SonderMind

SonderMind is focused on making mental health support more connected, personalized, and effective at every stage of life. Its care model spans therapy, medication management, meditation, and mindfulness, supported by digital tools and clinical research designed to improve outcomes and help clinicians build sustainable practices.

The company also expects team members to use modern AI tools as a regular part of their workflow and to keep adapting as new technologies emerge. Experience with relevant platforms such as Gemini, ChatGPT, Claude, GitHub Copilot, or similar productivity tools is considered an important part of succeeding in this environment.

About the Role

The Clinical Quality Specialist, Utilization Management is responsible for protecting clinical quality and integrity across the organization, with emphasis on utilization management, payor-facing clinical audits, and quality assurance. The role ensures services are medically necessary, properly documented, and aligned with evidence-based standards and payer expectations, while also supporting providers and maintaining compliant operations.

This is a highly collaborative position that blends clinical judgment with utilization review discipline and audit preparedness. It acts as a connection point between patient care, payer requirements, and internal quality standards.

Key Responsibilities

Utilization Management and Review

• Perform prospective, concurrent, and retrospective reviews to evaluate medical necessity, appropriateness of treatment, and level of care.
• Use evidence-based utilization management criteria to assess documentation and assist with authorization and appeal workflows.
• Watch utilization patterns and care intensity to spot outliers and guide focused provider support.
• Work with health plans on external utilization review requests and coordinate peer-to-peer reviews.

Clinical Quality and Provider Support

• Look into provider concerns arising from utilization findings, client complaints, or external reporting and help drive remediation.
• Monitor adverse clinical events and collaborate with cross-functional partners on early risk mitigation.
• Support measurement-based care efforts and identify ways to improve clinical outcomes across the provider network.

Reporting and Continuous Improvement

• Track utilization measures, review counts, and case outcomes to support quality improvement work.
• Highlight trends and process issues for leadership and help refine utilization management policies and workflows.

What Success Looks Like

• Reviews are completed accurately, within required timelines, and in line with payer and regulatory expectations.
• Findings lead to practical provider support plans and measurable gains in care appropriateness.
• Cases are handled independently with strong clinical reasoning, complete documentation, and limited supervision.
• Cross-functional teams view you as a trusted, solution-focused partner on quality and utilization topics.
• Provider relationships stay constructive and trust-based, even during remediation efforts.
• You proactively identify utilization trends and bring improvement ideas to leadership.

Qualifications

• Master’s degree in a mental health discipline.
• Active and unrestricted clinical license in good standing, such as LMFT, LPC, LCSW, LMHC, or a similar credential.
• Background in utilization management, utilization review, medical necessity review, or clinical auditing, preferably in behavioral health or a health plan environment.
• Working knowledge of payer requirements, medical necessity standards, and level-of-care guidance.
• Strong clinical decision-making skills and experience managing escalations, adverse events, or quality investigations.
• Ability to create clear, accurate, and defensible clinical documentation.
• Proven track record of working effectively across teams.
• Commitment to provider support and quality management.
• Comfort using clinical technology platforms for documentation, case tracking, and data analysis.

Benefits

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

Additional Information

This hiring process is ongoing and the role will remain open until it is filled.

SonderMind is an equal opportunity employer and does not discriminate 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 law.