Part-Time Clinical Quality Specialist

About SonderMind

SonderMind aims to provide a comprehensive and personalized mental health environment that supports individuals throughout their life stages. Their approach integrates therapy, medication management, and mindfulness exercises enhanced by digital tools and research to improve care quality and provider practices. Staff are encouraged to utilize emerging AI technologies like Gemini, ChatGPT, and GitHub Copilot to enhance workflow efficiency.

Role Overview

The part-time Clinical Quality Specialist safeguards and improves the clinical quality of services by focusing on utilization management, clinical audits, and quality assurance. This role ensures that care meets medical necessity, is properly documented, aligns with evidence-based and payor standards, supporting compliant and effective clinical operations. Collaboration between clinical teams, payors, and quality departments is essential.

Key Responsibilities

• Perform prospective, concurrent, and retrospective utilization reviews evaluating medical necessity and treatment appropriateness.
• Use evidence-based criteria for authorization support and appeals.
• Monitor care utilization trends and identify outliers for intervention.
• Coordinate with health plans on external utilization reviews and peer-to-peer discussions.
• Address provider concerns from utilization findings, complaints, or reports with remediation efforts.
• Monitor and mitigate adverse clinical events in collaboration with cross-functional teams.
• Support initiatives aimed at measurement-based care and strengthen clinical outcomes across providers.
• Track utilization metrics and case outcomes to guide quality improvement.
• Report trends and workflow gaps to leadership, advocating for continuous improvement.

Success Criteria

• Timely, accurate, and compliant completion of utilization reviews.
• Conversion of utilization findings into actionable provider support and improved care quality.
• Independent case management supported by sound clinical judgment and documentation.
• Recognition as a dependable collaborator on quality and utilization matters.
• Maintenance of constructive, trust-based relationships with providers, even during remediation.
• Proactive identification and communication of systemic utilization trends to leadership.

Candidate Profile

• Master’s degree in a mental health-related discipline.
• Active clinical license (e.g., LMFT, LPC, LCSW, LMHC) in good standing.
• Experience in utilization management, review, or clinical auditing preferably in behavioral health or health plans.
• Knowledge of payor standards, medical necessity, and level-of-care criteria.
• Strong clinical judgment with experience managing escalations and quality investigations.
• Capability to produce clear and defensible clinical documentation.
• Proven teamwork skills across diverse groups.
• Commitment to supporting providers and managing clinical quality.
• Familiarity with clinical tech platforms for documentation, case tracking, and data analysis.

Compensation

This role offers an hourly wage ranging from 40 to 42 dollars for up to 30 hours per week.

Equal Opportunity

The company is an equal opportunity employer committed to nondiscrimination based on any legally protected characteristic.