Clinical Quality Specialist

About SonderMind

SonderMind is focused on making mental health care more connected, personalized, and effective for people at every stage of life. Its platform combines therapy, medication management, meditation, mindfulness, and digital tools to help clinicians deliver better outcomes and build strong practices.

The company also expects team members to incorporate modern AI tools into everyday work and stay adaptable as new productivity technologies emerge. Experience with relevant tools such as Gemini, ChatGPT, Claude, GitHub Copilot, or similar AI platforms is considered an important part of success in this role.

About the Role

The Clinical Quality Specialist, Utilization Management position is responsible for protecting the clinical quality and integrity of care across the organization. The role centers on utilization management, payer-facing clinical audits, and quality assurance, with an emphasis on medical necessity, strong documentation, evidence-based standards, and compliance with payer requirements.

This is a highly collaborative position that supports providers while also applying disciplined utilization review practices. It connects clinical care, payer expectations, and internal quality standards to help ensure defensible and compliant operations.

Utilization Management and Review

• Perform prospective, concurrent, and retrospective reviews to determine whether care is medically necessary, appropriate, and matched to the correct level of care.
• Use evidence-based utilization management standards to evaluate documentation and assist with authorization and appeals work.
• Watch for patterns in care intensity and utilization to spot outliers and guide targeted support for providers.
• Work with health plans on external review requests and coordinate peer-to-peer review activities.

Clinical Quality and Provider Support

• Review and address provider issues that arise from utilization findings, client complaints, or outside reports.
• Track clinical adverse events and help reduce risk early in partnership with cross-functional teams.
• Support measurement-based care efforts and look for ways to improve outcomes across the provider network.

Reporting and Continuous Improvement

• Monitor utilization metrics, review volumes, and case results to support quality improvement work.
• Identify process gaps and trend patterns, then share recommendations with leadership to improve utilization management policies and workflows.

What Success Looks Like

• Utilization reviews are completed accurately, within deadlines, and in line with payer and regulatory expectations.
• Findings from reviews lead to practical provider support plans and better care appropriateness.
• Cases are handled independently with strong clinical reasoning, complete documentation, and limited supervision.
• Internal partners view you as a trusted, solutions-focused collaborator on quality and utilization topics.
• Provider relationships remain constructive and trust-based, even when remediation is needed.
• You identify broader utilization trends and bring improvement ideas to leadership proactively.

Candidate Profile

• Master’s degree in a mental health field.
• An active 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 payer/health plan setting.
• Working knowledge of payer rules, medical necessity standards, and level-of-care guidelines.
• Strong clinical judgment, including experience handling escalations, adverse events, or quality investigations.
• Ability to write clear, accurate, and supportable clinical documentation.
• Proven ability to collaborate effectively with multiple teams.
• A strong 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 PTO each year.
• Standard U.S. holiday schedule.
• Free therapy coverage for employees enrolled in a qualifying medical plan.
• Medical, dental, and vision plans, including HSA coverage with a $1,100 company contribution and FSA options.
• Employer-paid short-term disability, long-term disability, life insurance, and AD&D coverage, plus pay protection that covers the salary gap for up to seven weeks of short-term disability leave after the waiting period.
• Eight weeks of paid parental leave, with a total of 8–16 weeks available if the parent also qualifies for short-term disability.
• 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-wide shutdown between Christmas and New Year’s.
• Additional offerings such as supplemental life insurance, pet insurance, commuter benefits, and more.

Additional Information

This hiring process is ongoing and the opening will remain available until it is filled.

Equal Opportunity

SonderMind is an equal opportunity employer and does not make employment 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 protected characteristic under applicable federal, state, or local law.