Part-Time Clinical Quality Specialist

About SonderMind

SonderMind is committed to providing a personalized, connected, and effective destination for mental health care across all life stages. Our services include therapy, medication management, meditation, and mindfulness, supported by digital tools and research to enhance care quality and provider growth. The organization integrates technology with human connection to improve outcomes comprehensively.

All team members are expected to incorporate advanced AI technologies, such as Gemini, ChatGPT, Claude, GitHub Copilot, or other leading AI productivity tools, into their daily workflows, adapting continuously as these tools evolve.

Role Overview

The Part-Time Clinical Quality Specialist role focuses on maintaining and enhancing the clinical integrity and compliance of care across the company. Key areas of responsibility include utilization management, payor-focused clinical audits, and clinical quality assurance. This role ensures that care services meet medical necessity, proper documentation standards, and align with evidence-based best practices and payor requirements, facilitating provider success and defensible clinical practices.

This position requires collaboration and a provider-supportive approach, combining clinical judgment with rigorous utilization review and audit preparedness. The Specialist acts as a liaison between clinical teams, payor guidelines, and internal quality expectations. The role is part-time, allowing up to 30 hours per week.

Key Responsibilities

• Perform prospective, concurrent, and retrospective reviews of utilization to assess medical necessity, treatment suitability, and care level appropriateness.
• Use evidence-based utilization management criteria to review clinical documentation supporting authorization and appeals.
• Analyze care intensity and usage trends to identify anomalies and inform targeted corrective actions for providers.
• Collaborate with health plans to manage external utilization review requests and coordinate peer reviews.
• Investigate and address provider issues identified through utilization management findings, client feedback, or external sources.
• Monitor adverse clinical events and partner with cross-functional teams to implement early risk mitigation strategies.
• Support initiatives for measurement-based care and identify opportunities to enhance clinical outcomes across the provider network.
• Track and report utilization metrics, review activity, and case results to support quality improvement efforts.
• Identify trends and workflow gaps to inform leadership and contribute to continuous enhancement of utilization management policies.

Success Metrics

• Timely, accurate completion of utilization reviews that comply with payer and regulatory standards.
• Utilization management outcomes lead to actionable provider support plans and measurable improvements in care appropriateness.
• Independent handling of cases with solid clinical judgment, thorough documentation, and limited oversight.
• Recognition as a knowledgeable, collaborative partner by cross-functional teams on utilization and quality issues.
• Maintenance of trust-based, constructive relationships with providers throughout remediation efforts.
• Proactive identification of systemic utilization trends with recommendations for leadership-driven improvements.

Qualifications

• Master's degree in a mental health discipline.
• Active clinical license in good standing (e.g., LMFT, LPC, LCSW, LMHC, or equivalent).
• Experience with utilization management, review, medical necessity evaluations, or clinical audits, preferably in behavioral health or health plan settings.
• Knowledge of payor criteria, medical necessity standards, and level-of-care guidelines.
• Strong clinical reasoning skills, including experience managing escalations, adverse events, and quality investigations.
• Ability to document clinical findings clearly, accurately, and defensibly.
• Proven collaboration skills across multiple teams.
• Dedication to supporting providers and maintaining clinical quality.
• Familiarity with clinical technologies for documentation, case management, and data analysis to support quality and compliance.

Compensation and Details

The position offers an hourly wage between 40 and 42 USD, with work hours up to 30 per week.

Equal Opportunity Employer Statement

The company is committed to fair employment practices and does not discriminate based on race, color, creed, sex, gender identity or expression, pregnancy, childbirth or related medical conditions, religion, veteran or military status, marital or domestic partner status, age, national origin or ancestry, physical or mental disability, medical condition, sexual orientation, or any other characteristic protected by federal, state, or local law.