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 platform brings together therapy, medication management, mindfulness, and digital support tools so clinicians can deliver better outcomes and grow sustainable practices. The organization also expects team members to make practical use of modern AI tools in their day-to-day work and to stay adaptable as new technology becomes available.

Role overview

The Clinical Quality Specialist, Utilization Management, plays a key role in protecting the quality and integrity of care across the organization. The role centers on utilization management, payer-facing clinical audits, and quality assurance, with a focus on confirming medical necessity, maintaining strong documentation, and aligning care with evidence-based standards and payer requirements. It is a highly collaborative position that supports providers while helping ensure compliant, defensible clinical operations.

Key responsibilities

• Perform prospective, concurrent, and retrospective utilization reviews to evaluate medical necessity, treatment fit, and appropriate level of care.
• Use evidence-based utilization management criteria to assess clinical records and assist with authorization and appeal workflows.
• Observe care intensity and utilization patterns to spot unusual trends and guide focused provider support.
• Coordinate with health plans on external utilization review requests and peer-to-peer review scheduling.
• Address and help resolve provider issues arising from utilization findings, client concerns, or external reports.
• Track clinical adverse events and work with cross-functional partners on early risk-reduction actions.
• Support measurement-based care efforts and identify ways to improve clinical outcomes across the provider network.
• Monitor review volume, utilization metrics, and case outcomes to support quality improvement initiatives.
• Share emerging trends and workflow gaps with leadership and contribute to updates in utilization management policy and process.

What success in this role looks like

• Reviews are completed accurately, within required timelines, and in line with payer and regulatory expectations.
• Utilization findings lead to practical provider support plans and measurable gains in care appropriateness.
• Cases are managed independently with strong clinical reasoning, complete documentation, and limited supervision.
• Cross-functional colleagues view you as a dependable, solution-focused partner on quality and utilization topics.
• Provider relationships remain respectful and constructive, even during remediation work.
• You proactively identify broader utilization patterns and bring improvement ideas to leadership.

Candidate profile

The ideal candidate brings a master’s degree in a mental health field and an active, unrestricted 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 environment. The role also calls for familiarity with payer rules, medical necessity standards, and level-of-care guidance, along with the ability to manage escalations, adverse events, and quality investigations with sound judgment.

Strong written documentation skills, cross-team collaboration, and a consistent commitment to provider support and quality management are important. Experience using clinical systems for documentation, case tracking, and data analysis is also beneficial. Team members are expected to incorporate relevant AI productivity tools into their workflow as part of everyday work.

Benefits

• At least three weeks of paid time off each year.
• U.S. standard holiday schedule.
• Free therapy coverage for employees enrolled in a qualifying medical plan.
• Medical, dental, and vision coverage, including HSA and FSA options; HSA plans include a $1,100 company contribution.
• Employer-paid short-term disability, long-term disability, life insurance, and accidental death & dismemberment coverage, plus salary-top-up support 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 to 16 weeks of paid leave 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 teammates from across the country.
• Company shutdown between Christmas and New Year’s.
• Additional perks such as supplemental life insurance, pet insurance, commuter benefits, and more.

Additional information

This position is being recruited on an ongoing basis and will remain open until it is filled.

Equal opportunity statement

SonderMind is an equal opportunity employer and considers all applicants without regard to legally protected characteristics, including race, color, creed, sex, gender identity or expression, pregnancy, religion, veteran status, marital status, age, national origin, disability, medical condition, sexual orientation, and other protected categories under applicable law.