Part-Time Clinical Quality Specialist

About SonderMind

SonderMind is dedicated to offering a comprehensive mental health experience tailored to each individual's needs, combining therapy, medication management, and mindfulness tools to enhance well-being throughout life stages. Our clinicians utilize both digital innovation and research to maintain high care standards and develop thriving practices, integrating technology with human connection to improve outcomes.

Team members are expected to proficiently use AI-based productivity tools like Gemini, ChatGPT, Claude, and GitHub Copilot as part of daily workflows and adapt continuously as new AI technologies arise.

Role Overview

The Clinical Quality Specialist works part-time (up to 30 hours per week) to uphold and enhance clinical care quality, focusing on utilization management, payor-centered clinical audits, and clinical quality assurance. This role ensures medical services are necessary, accurately documented, and comply with evidence-based standards and payor guidelines to support provider success and maintain regulatory compliance. The role involves close collaboration between clinical care teams, payors, and internal quality control.

Key Responsibilities

• Perform comprehensive utilization reviews (prospective, concurrent, retrospective) assessing medical necessity, treatment suitability, and care level.
• Use evidence-based utilization management criteria to evaluate clinical documentation, supporting authorization and appeals.
• Monitor intensity and utilization trends to identify anomalies and guide provider interventions.
• Collaborate with health plans on external utilization review requests and coordinate peer-to-peer reviews.
• Address and resolve provider concerns related to utilization management findings, client complaints, or external inputs.
• Track and mitigate early-stage risks connected to clinical adverse events with cross-team collaboration.
• Promote measurement-based care and identify enhancement opportunities within the provider network.
• Analyze utilization metrics, review volumes, and case results to drive continuous quality improvements.
• Identify trends and process gaps to inform leadership and refine utilization management policies and workflows.

Indicators of Success

• Completion of accurate, timely utilization reviews aligned with payer and regulatory standards.
• Generation of actionable provider support initiatives resulting in improved care appropriateness.
• Independent handling of cases supported by strong clinical reasoning and thorough documentation.
• Recognition as a collaborative and knowledgeable partner by cross-functional teams on utilization and quality matters.
• Maintenance of constructive, trust-based provider relationships, even in remediation contexts.
• Proactive identification and communication of systemic utilization trends with leadership recommendations.

Candidate Profile

• Holds a master’s degree in a mental health field.
• Maintains an active, clear clinical license such as LMFT, LPC, LCSW, LMHC, or equivalent in good standing.
• Experience in utilization management, review, medical necessity, or clinical auditing, preferably in behavioral health or payor environments.
• Knowledge of payor criteria, medical necessity guidelines, and levels of care.
• Strong clinical judgment with experience managing escalations, adverse events, and quality investigations.
• Proven skill in producing clear, accurate, and defensible clinical records.
• Adept at collaborating across multiple teams with a commitment to provider support and quality control.
• Familiar with clinical technology systems for documentation, case tracking, and compliance data analysis.

Compensation & Application

This position offers an hourly pay range of $40 to $42, with up to 30 hours allowed weekly. Recruitment is ongoing until the role is filled.

Equal Opportunity

SonderMind is an equal opportunity employer and prohibits discrimination based on a broad range of protected characteristics including race, gender identity, age, disability, and more as mandated by applicable laws.