Part-Time Clinical Quality Specialist

About SonderMind

SonderMind is dedicated to providing personalized, connected, and effective mental health care for individuals at every life stage. Their comprehensive services cover therapy, medication management, and mindfulness techniques, supported by innovative digital tools and research. The organization emphasizes combining technology with human interaction to enhance clinical outcomes and practice growth.

SonderMind promotes the use of AI technologies including Gemini, ChatGPT, Claude, and GitHub Copilot as integral to daily work, expecting team members to adapt continually to emerging AI platforms.

Role Overview

The Part-Time Clinical Quality Specialist is tasked with maintaining and enhancing clinical standards across the company, with a concentration on utilization management, payor-related clinical audits, and quality assurance. This role ensures clinical care is medically necessary, properly documented, and aligns with evidence-based practices and payor requirements to facilitate provider success while ensuring compliant operations.

The position balances clinical insight with strict utilization review duties and audit preparedness, serving as a liaison among clinical care teams, payor expectations, and internal quality guidelines. This role is part-time, offering up to 30 hours weekly.

Key Responsibilities

• Perform prospective, concurrent, and retrospective utilization reviews to evaluate medical necessity, appropriateness of treatment, and care level.
• Utilize evidence-based utilization management criteria to assess clinical documentation supporting approvals and appeals.
• Identify care intensity patterns and utilization trends to detect anomalies and direct provider intervention efforts.
• Coordinate with health plans on external utilization review requests and peer-to-peer discussions.
• Address and resolve provider issues arising from utilization findings, client feedback, or external reports.
• Oversee monitoring of clinical adverse events and collaborate on early risk mitigation with cross-disciplinary teams.
• Facilitate measurement-based care initiatives to enhance clinical outcomes within the provider network.
• Analyze utilization data and review outcomes to guide ongoing quality improvement.
• Highlight trends and process inefficiencies for leadership, contributing to policy and workflow enhancements in utilization management.

Success Indicators

• Accurate and timely completion of utilization reviews aligned with payer and regulatory standards.
• Effective translation of utilization review insights into actionable provider support strategies and improved care appropriateness.
• Independent case management demonstrating sound clinical judgment and thorough documentation with minimal oversight.
• Trusted collaboration with cross-functional teams on utilization management and quality-related matters.
• Maintenance of constructive, trust-based relationships with providers through remediation efforts.
• Proactive identification of systemic utilization trends, offering strategic improvement recommendations to leadership.

Candidate Profile

• Master's degree in a mental health field.
• Current and good-standing clinical license such as LMFT, LPC, LCSW, LMHC, or equivalent.
• Experience in utilization management, utilization review, clinical auditing, or medical necessity review, preferably within behavioral health or health plan settings.
• Understanding of payer criteria, medical necessity standards, and care level guidelines.
• Strong clinical decision-making skills with experience in handling escalations, adverse event investigations, or quality assurance evaluations.
• Ability to create clear, accurate, and defensible clinical documentation.
• Proven effectiveness in teamwork and interdisciplinary collaboration.
• Dedication to supporting providers and maintaining quality oversight.
• Competency with clinical technology platforms for documentation, case monitoring, and data analysis supporting compliance and quality.

Compensation

The position pays an hourly wage between $40.00 and $42.00, with a weekly commitment of up to 30 hours.

Application

Applications will be accepted on a rolling basis until the role is filled.

Equal Opportunity

SonderMind is an equal opportunity employer that prohibits discrimination based on race, color, creed, sex, gender identity, pregnancy, medical conditions, religion, veteran status, marital status, registered domestic partnership, age, national origin, physical or mental disabilities, sexual orientation, or other characteristics protected by law.