Part-Time Clinical Quality Specialist

About SonderMind

SonderMind is dedicated to providing a personalized, integrated mental health experience for individuals at every stage of life. Our services range from therapy and medication management to meditation and mindfulness practices. By integrating advanced digital tools and research, our clinicians deliver high-quality care and foster thriving practices, merging technology with human connection to drive superior outcomes. To stay engaged with SonderMind, follow our latest updates on social media platforms.

Our team is expected to proficiently utilize contemporary AI platforms like Gemini, ChatGPT, Claude, GitHub Copilot, and other leading AI productivity tools as a component of their daily responsibilities, adapting continuously as new technology arises.

Role Overview

The Part-Time Clinical Quality Specialist plays a crucial role in upholding and enhancing the clinical standards across our organization. Focused on utilization management, payor-based clinical audits, and quality assurance, this position ensures delivered care is medically necessary, properly documented, and compliant with evidence-based and payor standards to support clinical operations and provider success.

This position blends clinical expertise with thorough utilization review and audit readiness, acting as a vital liaison bridging clinical care providers, payors, and internal quality benchmarks. This role is part-time, offering up to 30 hours weekly at our Denver, CO location.

Key Responsibilities

• Perform utilization reviews prospectively, concurrently, and retrospectively to evaluate medical necessity, treatment suitability, and appropriate care level.
• Implement evidence-based utilization management criteria to assess clinical documentation, supporting authorization and appeal workflows.
• Monitor clinical service intensity and utilization patterns to identify anomalies and guide targeted interventions with providers.
• Collaborate with health plans to manage external utilization review requests and coordinate peer-to-peer reviews.
• Address provider issues emerging from utilization management findings, client complaints, or external inputs.
• Track and remediate clinical adverse events in partnership with cross-functional teams to mitigate risks early.
• Support initiatives promoting measurement-based care and propose ways to enhance clinical outcomes within the provider network.
• Collect and report on utilization metrics, review caseloads, and outcomes to facilitate quality improvements.
• Identify systemic trends and procedural inefficiencies to advise leadership and refine utilization management policies.

Success Indicators

• Timely, accurate completion of utilization reviews that comply with payer and regulatory mandates.
• Utilization management insights result in actionable provider support and measurable improvements to care appropriateness.
• Independent case handling with sound clinical reasoning and comprehensive documentation requiring minimal supervision.
• Recognition by interdisciplinary teams as a resourceful and collaborative partner on utilization and quality issues.
• Maintain constructive, trust-based relations with providers, even during remediation activities.
• Proactively detect utilization patterns and recommend improvements to leadership.

Candidate Profile

• Master’s degree in a mental health field.
• Current and valid clinical license such as LMFT, LPC, LCSW, LMHC, or equivalent in good standing.
• Experience with utilization management or clinical auditing, preferably in behavioral health or payor/health insurance settings.
• Knowledgeable about payor standards, medical necessity criteria, and levels of care guidelines.
• Strong clinical decision-making skills, including experience managing escalations and quality-related investigations.
• Proficient in producing clear and defensible clinical documentation.
• Effective collaborator across multidisciplinary teams.
• Dedicated to provider support and quality maintenance.
• Experienced using clinical technology systems for documentation, case monitoring, and data analysis to improve provider quality and compliance.

Compensation and Terms

This part-time role offers an hourly rate ranging from 40 to 42 dollars, with up to 30 work hours per week.

Equal Employment Opportunity

SonderMind is committed to providing equal employment opportunities without regard to race, color, gender, gender identity/expression, pregnancy, religion, veteran status, marital status, age, nationality, disability, medical condition, sexual orientation, or any other characteristic protected by law.