Part-Time Clinical Quality Specialist

About SonderMind

SonderMind is dedicated to providing a personalized, integrated mental health care experience throughout all life stages. We offer comprehensive services ranging from therapy and medication management to meditation and mindfulness, leveraging technology and evidence-based approaches to enhance care quality. Our clinicians utilize innovative digital tools and research to foster thriving practices and better outcomes. We also emphasize the use of current AI technologies like Gemini, ChatGPT, Claude, and GitHub Copilot to enhance workflows and adapt to emerging tools.

Role Overview

The Part-Time Clinical Quality Specialist plays a vital role in maintaining and enhancing clinical care standards organization-wide. The position focuses on utilization management, payor-related clinical audits, and ensuring compliance with clinical quality assurance mandates. This role safeguards appropriate, medically necessary care that meets documentation standards and payor requirements, facilitating provider success and adherence to compliant clinical operations. This collaborative position merges clinical judgment with rigorous utilization review and audit readiness, serving as a bridge among clinical teams, payors, and internal quality benchmarks. The opportunity is part-time, with up to 30 hours weekly.

Key Responsibilities

• Perform prospective, concurrent, and retrospective utilization reviews to evaluate medical necessity, treatment appropriateness, and care level.
• Apply evidence-based UM criteria to clinical documentation supporting authorizations and appeals.
• Monitor care intensity and utilization patterns to identify outlier cases and guide provider interventions.
• Collaborate with health plans on external utilization review requests and coordinate peer-to-peer reviews.
• Address and resolve provider concerns arising from utilization management findings, client complaints, or external reports.
• Oversee clinical adverse events and implement early risk mitigation strategies in conjunction with cross-functional teams.
• Support initiatives promoting measurement-based care and identify ways to improve clinical outcomes across the provider network.
• Track utilization data, review volumes, and case outcomes to drive continuous quality improvement.
• Identify trends and process gaps, report findings to leadership, and contribute to UM policy and workflow enhancements.

Success Indicators

• Accurate, timely utilization reviews compliant with payer and regulatory standards.
• Findings from utilization management translate into actionable support plans and measurable care improvements.
• Independent case management with sound clinical judgment, detailed documentation, and limited supervision.
• Trusted collaboration with cross-functional teams on UM and quality efforts.
• Maintaining constructive, trust-based provider relationships even during remediation activities.
• Proactively identifying systemic utilization trends and presenting recommendations to leadership.

Candidate Profile

• Possesses a Master’s degree in a mental health-related field.
• Holds an active, in-good-standing clinical license such as LMFT, LPC, LCSW, LMHC, or equivalent.
• Has experience with utilization management, clinical auditing, medical necessity reviews, ideally within behavioral health or health plan environments.
• Understands payor requirements, medical necessity standards, and level-of-care guidelines.
• Exhibits strong clinical judgment, especially in managing escalations, adverse events, and quality investigations.
• Proficient in producing clear, accurate, and defensible clinical documentation.
• Demonstrates effective collaboration across diverse teams.
• Committed to provider support and quality management principles.
• Familiar with clinical technology platforms for documentation, case monitoring, and analytics to enhance provider compliance and quality.

Compensation and Terms

The role offers an hourly wage ranging from $40 to $42, with a maximum of 30 working hours per week. Recruitment for this position will continue until the role is filled.

Equal Opportunity Statement

SonderMind ensures equal employment opportunities without discrimination based on race, color, creed, gender identity or expression, pregnancy, religion, veteran status, marital or domestic partner status, age, national origin, disability, medical condition, sexual orientation, or any other protected characteristics under applicable laws.