Part-Time Clinical Quality Specialist

About SonderMind

SonderMind offers a comprehensive mental health destination, providing tailored care including therapy, medication management, and mindfulness practices. The organization integrates digital tools with clinical expertise to ensure high-quality care and support thriving clinical practices.

Team members are expected to proficiently use cutting-edge AI technologies such as Gemini, ChatGPT, Claude, and GitHub Copilot to enhance workflow efficiency and remain adaptable to emerging tools.

Role Overview

The Part-Time Clinical Quality Specialist plays a crucial role in preserving clinical excellence through utilization management, clinical audits with payors, and quality assurance. The position focuses on verifying medical necessity and documentation accuracy, ensuring compliance with evidence-based standards and payor requirements to support providers and maintain compliant operations.

Responsibilities

• Perform utilization reviews prospectively, concurrently, and retrospectively to evaluate medical necessity, appropriateness, and level of care.
• Utilize evidence-based criteria to assess clinical documentation and aid authorization and appeals.
• Identify utilization trends and outliers to guide targeted provider interventions.
• Coordinate external utilization review requests and peer-to-peer reviews with health plans.
• Address and resolve provider concerns arising from utilization findings, complaints, or reports.
• Monitor adverse clinical events and collaborate on early risk mitigation strategies.
• Promote measurement-based care initiatives to enhance clinical outcomes within the provider network.
• Maintain comprehensive tracking of utilization metrics and case outcomes to support quality improvement.
• Highlight trends and process improvements to leadership, refining policies and workflows.

Success Indicators

• Timely and accurate completion of utilization reviews compliant with payer and regulations.
• Implementation of actionable provider support plans that improve care appropriateness.
• Independent case management with sound clinical judgment and thorough documentation.
• Recognition as a knowledgeable, collaborative partner across teams on quality matters.
• Maintaining constructive, trust-based relationships with providers, even when addressing issues.
• Proactive identification of systemic utilization trends with recommendation of improvements.

Qualifications

• Master's degree in a mental health discipline.
• Active and clear clinical license (e.g., LMFT, LPC, LCSW, LMHC) in good standing.
• Experience in utilization management, review, medical necessity evaluation, or clinical auditing, preferably in behavioral health or health plan settings.
• Understanding of payor requirements, medical necessity standards, and level-of-care guidelines.
• Strong clinical judgment with experience in handling escalations, adverse events, and quality investigations.
• Proven ability to produce clear, defensible clinical documentation.
• Effective collaboration skills across multiple teams.
• Dedication to supporting providers and managing quality.
• Familiarity with clinical tech platforms for documentation, case tracking, and data analysis.

Compensation

The role offers an hourly wage ranging from $40 to $42, with a maximum of 30 working hours per week.

Equal Opportunity

SonderMind is an equal opportunity employer and prohibits discrimination in employment based on race, color, creed, sex, gender identity or expression, pregnancy, childbirth, religion, veteran status, marital status, domestic partnership, age, national origin, disability, medical conditions, sexual orientation, or any protected characteristic under federal, state, or local laws.