Part-Time Clinical Quality Specialist

About SonderMind

SonderMind is dedicated to providing personalized, connected, and effective mental health care tailored to every stage of life. Their services range from therapy and medication management to mindfulness practices, supported by advanced digital tools and research to enhance care quality and support thriving clinical practices. Through a blend of technology and human interaction, SonderMind aims for superior mental health outcomes. Employees are expected to proficiently use modern AI tools like Gemini, ChatGPT, Claude, and GitHub Copilot as part of their routine, embracing continual adaptation to evolving technologies.

Role Overview

The Part-Time Clinical Quality Specialist safeguards clinical care quality across the organization, focusing on utilization management, payor-related clinical audits, and quality assurance. This position ensures treatment is medically necessary, appropriately recorded, and compliant with evidence-based standards and payor policies to support clinicians and maintain compliant care operations. It’s a collaborative role requiring clinical insight and rigorous review practices, acting as a bridge between clinical care, payer regulations, and internal quality standards. The part-time position involves up to 30 hours per week onsite in Salt Lake City, UT.

Key Responsibilities

• Perform prospective, concurrent, and retrospective utilization reviews assessing medical necessity, suitability of treatment, and appropriate levels of care.
• Utilize evidence-based criteria to evaluate clinical documentation supporting authorizations and appeals.
• Analyze utilization patterns to detect outliers and guide targeted interventions for providers.
• Collaborate with health plans on external utilization review requests and coordinate peer-to-peer reviews.
• Address and resolve provider concerns resulting from utilization findings, client complaints, or external reports.
• Monitor adverse clinical events and initiate early risk mitigation alongside cross-department teams.
• Support initiatives enhancing clinical outcomes through measurement-based care in the provider network.
• Track usage metrics and case results to drive quality improvements.
• Identify trends and process shortcomings for leadership and help refine utilization management policies and workflows.

Success Indicators

• Timely and accurate completion of utilization reviews compliant with payer and regulatory standards.
• Utilization review outcomes lead to actionable support plans and demonstrable care improvements.
• Independent case management with sound judgment and well-documented processes.
• Recognized by cross-functional teams as a knowledgeable and collaborative resource on utilization and quality issues.
• Maintaining trusted and constructive relationships with providers during remediation.
• Proactively detecting systemic utilization trends and proposing improvements to leadership.

Qualifications

• Master’s degree in a mental health field.
• Current and active clinical license (e.g., LMFT, LPC, LCSW, LMHC) in good standing.
• Experience with utilization management, utilization review, medical necessity evaluation, or clinical audits, preferably within behavioral health or payor contexts.
• Understanding of payor regulations, medical necessity frameworks, and care level criteria.
• Strong clinical judgment with experience managing escalations, adverse event investigations, or quality control processes.
• Proven ability to create clear, accurate, and defensible clinical documentation.
• Demonstrated ability to collaborate effectively across multiple teams.
• Dedication to supporting providers and enhancing quality management.
• Familiarity with clinical software platforms designed for documentation, case monitoring, and data analysis supporting quality and compliance.

Compensation

The position offers an hourly wage ranging from 40 to 42 USD, with a maximum of 30 work hours per week.

Additional Information

This is an ongoing recruitment, with the position open until filled. SonderMind is an equal employment opportunity employer committed to diversity and prohibits discrimination on legally protected bases including race, gender, religion, veteran status, age, disability, sexual orientation, or other protected characteristics.