Part-Time Clinical Quality Specialist

About SonderMind

SonderMind is dedicated to providing a personalized, integrated mental health care platform that supports individuals at every stage of life. Our services range from therapy and medication management to mindfulness practices. Clinicians utilize digital tools and evidence-based research to enhance care quality and develop thriving practices, blending technology with human empathy to improve outcomes.

All team members are expected to incorporate modern AI technologies such as Gemini, ChatGPT, Claude, or GitHub Copilot into daily workflows, adapting as new tools evolve, which is crucial for success at SonderMind.

Position Summary

The Part-Time Clinical Quality Specialist role is integral to maintaining and enhancing the clinical standards of care across the organization. Focusing on utilization management, clinical audits with payors, and quality assurance, this position ensures that care is medically justified, thoroughly documented, aligns with evidence-based practices, and meets payor standards to support both provider success and compliant operations.

Key Responsibilities

• Perform prospective, concurrent, and retrospective utilization reviews to evaluate medical necessity, treatment suitability, and appropriate levels of care.
• Utilize evidence-based utilization management criteria to assess clinical documentation, aiding authorization and appeal procedures.
• Track care intensity and utilization trends to find anomalies and guide targeted provider interventions.
• Coordinate with health plans on external utilization review requests and facilitate peer-to-peer reviews.
• Address and resolve provider concerns arising from utilization management findings, client feedback, or external reports.
• Monitor clinical adverse events and apply early-stage risk reduction strategies alongside cross-functional teams.
• Support initiatives focused on measurement-based care and identify opportunities to improve clinical outcomes across the provider network.
• Maintain utilization metrics, case volumes, and outcomes to inform ongoing quality enhancement efforts.
• Identify trends and gaps to leadership, promoting continuous improvement of utilization management policies and procedures.

Success Criteria

• Accurate, timely utilization reviews complying with payer and regulatory standards.
• Transformation of utilization findings into actionable support plans that enhance care appropriateness.
• Independent case management demonstrating sound clinical judgment and comprehensive documentation.
• Trusted collaborative partner across departments on utilization management and quality issues.
• Maintenance of constructive, trust-based relationships with providers, even during remediation.
• Proactive identification of systemic utilization trends with recommendations presented to leadership.

Candidate Profile

• Master's degree in a mental health field.
• Active, clear clinical license in good standing (LMFT, LPC, LCSW, LMHC, or equivalent).
• Experience with utilization management, utilization review, medical necessity review, or clinical auditing, preferably within behavioral health or payor/health plan environments.
• Knowledge of payor requirements, medical necessity standards, and level-of-care criteria.
• Strong clinical decision-making skills, experienced in managing escalations, adverse events, and quality investigations.
• Ability to generate clear, precise, and defensible clinical documentation.
• Proven effectiveness in collaborating across multiple teams.
• Dedication to provider support and clinical quality management.
• Competence with clinical technology platforms for documentation, case management, and data analysis to aid provider compliance and quality.

Compensation and Terms

The position offers a part-time schedule of up to 30 hours weekly, with an hourly wage ranging between $40 and $42.

Additional Information

Recruitment is ongoing until the role is filled.

Equal Opportunity Employer Statement

SonderMind is committed to nondiscrimination in employment based on race, color, creed, gender, gender identity or expression, pregnancy or related medical conditions, religion, veteran or military status, marital status, domestic partnership status, age, national origin, physical or mental disability, medical conditions (including genetic information), sexual orientation, or other legally protected characteristics.