Clinical Quality Specialist

About the Organization

SonderMind is focused on making mental health care more connected, personalized, and effective for people at every stage of life. Its care model spans therapy, medication management, meditation, and mindfulness, supported by digital tools and research that help clinicians improve outcomes and build sustainable practices.

The company expects team members to use modern AI tools as part of their everyday work and to stay current as new technologies emerge. Experience with workplace AI platforms such as Gemini, ChatGPT, Claude, GitHub Copilot, or similar productivity tools is considered important for success.

Role Overview

The Clinical Quality Specialist, Utilization Management helps protect the quality and clinical soundness of care across the organization. The role centers on utilization management, payor-facing clinical audits, and quality assurance, with responsibility for confirming that care is medically necessary, well documented, evidence-based, and aligned with payer standards.

This is a highly collaborative position that supports providers while balancing clinical judgment, review rigor, and audit preparedness. The specialist acts as a connection point between care delivery, payer expectations, and internal quality requirements.

Key Responsibilities

You will review care across the full utilization cycle, support provider remediation, monitor quality trends, and help improve clinical processes and outcomes.

• Perform prospective, concurrent, and retrospective reviews to evaluate medical necessity, treatment fit, and the appropriate level of care.
• Use evidence-based utilization management standards to assess documentation and support authorization or appeal activity.
• Watch utilization patterns and care intensity trends to spot outliers and guide targeted provider support.
• Work with health plans on external review requests and coordinate peer-to-peer review activity.
• Address provider issues that arise from utilization findings, client complaints, or outside reports, and help resolve them.
• Track adverse clinical events and help reduce risk early in partnership with other teams.
• Support measurement-based care efforts and look for ways to improve outcomes across the provider network.
• Maintain utilization metrics, review counts, and case outcomes to support quality improvement work.
• Identify trends and process breakdowns, then share recommendations with leadership to improve policies and workflows.

What Success Looks Like

• Reviews are completed accurately, within required timelines, and in line with payer and regulatory standards.
• Utilization findings lead to practical provider support plans and measurable gains in care appropriateness.
• Cases are handled independently with strong clinical reasoning, complete documentation, and limited supervision.
• Cross-functional partners view you as a dependable, solutions-focused resource for utilization and quality matters.
• Provider relationships stay constructive and trust-based even when remediation is needed.
• You identify broader utilization trends early and bring improvement ideas to leadership.

Required Background

• A master’s degree in a mental health-related discipline.
• An active, cleared clinical license in good standing, such as LMFT, LPC, LCSW, LMHC, or an equivalent credential.
• Experience with utilization management, utilization review, medical necessity review, or clinical auditing, preferably in behavioral health or a health plan/payor setting.
• Working knowledge of payor rules, medical necessity standards, and level-of-care guidelines.
• Strong clinical judgment and experience managing escalations, adverse events, or quality investigations.
• Ability to write clear, accurate, and defensible clinical documentation.
• Proven skill in collaborating effectively across multiple teams.
• A commitment to provider support and quality management.
• Comfort using clinical technology platforms for documentation, case tracking, and data analysis.

Benefits

• At least three weeks of paid time off each year.
• Paid holidays aligned with standard U.S. holidays.
• Free therapy coverage for employees enrolled in a qualifying medical plan.
• Medical, dental, and vision coverage, including HSA and FSA options, with a $1,100 company HSA contribution.
• Employer-paid short-term disability, long-term disability, life insurance, and AD&D coverage, plus salary-difference support for up to seven weeks of short-term disability leave after the waiting period.
• Eight weeks of paid parental leave, with a total of 8 to 16 weeks possible when combined with short-term disability benefits.
• A 401(k) plan with a 100% match on contributions up to 4% of base salary, vested immediately.
• An annual company gathering with teammates from across the country.
• A company shutdown between Christmas and New Year’s.
• Supplemental life insurance, pet insurance, commuter benefits, and additional perks.

Additional Information

This hiring process is open-ended and will remain active until the position is filled.

Equal Opportunity

SonderMind states that employment decisions are made without discrimination based on race, color, creed, sex, gender, gender identity or expression, pregnancy, childbirth or related medical conditions, religion, veteran or military status, marital status, registered domestic partner status, age, national origin or ancestry, physical or mental disability, medical condition including genetic information or characteristics, sexual orientation, or any other legally protected characteristic.