Part-Time Clinical Quality Specialist

About SonderMind

SonderMind provides a personalized, connected mental health platform that supports well-being at every life stage through therapy, medication management, and mindfulness exercises. Their clinicians utilize digital tools and research to ensure high-quality, effective care, integrating technology with human interaction to achieve superior clinical outcomes.

All team members are expected to use current AI technologies in daily tasks and adapt to emerging tools. Familiarity with AI platforms such as Gemini, ChatGPT, Claude, and GitHub Copilot is essential for success.

Role Overview

The Part-Time Clinical Quality Specialist ensures clinical care integrity by focusing on utilization management, clinical audits related to payors, and quality assurance. This role verifies medical necessity, accurate documentation, and compliance with evidence-based standards and payor policies, supporting provider success and regulatory adherence.

Working collaboratively, the Specialist bridges clinical care, payor expectations, and internal quality standards, combining clinical judgment with utilization review rigor. This part-time role involves up to 30 hours per week onsite in San Antonio, TX.

Key Responsibilities

• Perform prospective, concurrent, and retrospective utilization reviews assessing medical necessity, appropriateness, and care level.
• Use evidence-based criteria to evaluate documentation for authorization and appeals.
• Track care intensity and utilization patterns to identify outliers and guide provider interventions.
• Coordinate with health plans for external utilization review requests and peer-to-peer discussions.
• Address provider issues from utilization findings, complaints, or external feedback.
• Monitor clinical adverse events and collaborate on early risk management with other teams.
• Support initiatives on measurement-based care and improve clinical outcomes across the provider network.
• Analyze utilization data and outcomes to recommend quality improvement measures.
• Report trends and process inefficiencies to leadership, helping refine relevant policies and procedures.

Success Indicators

• Accurate, timely utilization reviews compliant with payer and regulatory standards.
• Utilization findings lead to actionable provider support and improved care quality.
• Independent case management with sound clinical reasoning and documentation.
• Recognition as a collaborative expert on utilization management and quality by cross-functional teams.
• Maintain trustful, constructive provider relationships during remediation.
• Identify systemic trends and propose improvements to leadership proactively.

Qualifications

• Master's degree in a mental health field.
• Active, valid clinical license (e.g., LMFT, LPC, LCSW, LMHC, or equivalent) in good standing.
• Experience in utilization management, review, medical necessity assessment, or clinical audits, preferably in behavioral health or payor contexts.
• Knowledge of payor requirements, medical necessity, and level-of-care guidelines.
• Strong clinical judgment with experience managing escalations, adverse events, and quality investigations.
• Proven ability to create clear, accurate, defensible clinical documentation.
• Effective collaboration skills across multiple teams.
• Dedication to supporting providers and managing clinical quality.
• Familiarity with clinical technology for documentation, case tracking, and data analysis.

Compensation

The position offers an hourly wage between 40 and 42 USD, with a workload of up to 30 hours weekly.

Equal Opportunity Statement

SonderMind is committed to providing equal employment opportunities regardless of race, color, creed, sex, gender identity or expression, pregnancy, medical conditions, religion, veteran status, marital or domestic partnership status, age, national origin, disability, sexual orientation, or any legally protected characteristics.