Part-Time Clinical Quality Specialist

About SonderMind

SonderMind is dedicated to providing a comprehensive, personalized mental health care experience that supports individuals at every stage of life. Our services include therapy, medication management, meditation, and mindfulness exercises. We empower clinicians with innovative digital tools and research-based approaches to improve care quality and foster successful practices. Combining technology and meaningful human connections, SonderMind aims to enhance outcomes through a holistic care model.

All team members are expected to utilize AI technologies effectively in their daily work, adapting to new tools as they become available. Familiarity with AI platforms like Gemini, ChatGPT, Claude, and GitHub Copilot is considered essential for success.

Role Overview

The Part-Time Clinical Quality Specialist role is focused on maintaining and enhancing the clinical quality of care across the organization. The position emphasizes utilization management, conducting clinical audits with payors, and quality assurance to ensure care meets medical necessity standards, is well-documented, and aligns with evidence-based criteria and payor mandates. This role supports both provider performance and compliant clinical operations.

The Specialist will act as a vital link between clinical services, payor requirements, and internal quality guidelines in a provider-friendly and collaborative environment.

This is a part-time position allowing up to 30 hours of work per week.

Key Responsibilities

• Perform prospective, concurrent, and retrospective utilization reviews to evaluate medical necessity, treatment appropriateness, and care levels.
• Use evidence-based utilization management criteria to assess clinical documentation, supporting authorization and appeals.
• Analyze care utilization patterns and intensity to detect outliers and recommend targeted interventions for providers.
• Collaborate with health plans on external utilization review requests and coordinate peer-to-peer reviews.
• Address and resolve provider concerns arising from utilization findings, client feedback, or external reports.
• Monitor adverse clinical events and work with cross-functional teams on early risk mitigation strategies.
• Assist in measurement-based care initiatives to improve clinical outcomes within the provider network.
• Track utilization data, review volumes, and outcomes to guide quality enhancement efforts.
• Identify trends and workflow gaps, providing insight to leadership and aiding continuous improvement of UM policies.

Indicators of Success

• Timely and accurate completion of utilization reviews adhering to payer and regulatory standards.
• UM findings lead to actionable provider support and improvements in care appropriateness.
• Independent case management with sound clinical judgment, thorough documentation, and minimal oversight required.
• Recognition as a knowledgeable and collaborative partner on utilization and quality matters.
• Maintenance of trusting and constructive relationships with providers through remediation processes.
• Proactive identification of systemic utilization trends with recommendations for leadership action.

Candidate Profile

• Master’s degree in mental health disciplines.
• Active clinical license in good standing (e.g., LMFT, LPC, LCSW, LMHC, or equivalent).
• Experience in utilization management, clinical review, or audits, preferably in behavioral health or payer settings.
• Understanding of payor policies, medical necessity criteria, and level-of-care guidelines.
• Strong clinical decision-making skills with experience managing escalations and quality investigations.
• Ability to produce detailed, clear, and defensible clinical documentation.
• Proven collaborative skills across multiple teams.
• Commitment to supporting providers and enhancing quality management.
• Competency in clinical technology systems for documentation, case tracking, and data analysis.

Compensation & Application

This role offers an hourly wage between 40 and 42 dollars, with a maximum of 30 hours per week.

The recruitment will remain active until the position is filled.

Equal Opportunity Employer

SonderMind is committed to equal employment opportunities without regard to race, color, creed, gender identity or expression, pregnancy, religion, veteran status, marital or domestic partnership status, age, disability, medical conditions, sexual orientation, or other protected characteristics as mandated by law.