Clinical Quality Specialist

About the company

SonderMind is focused on creating a connected mental health experience that helps people access personalized care throughout different stages of life. Its offering spans therapy, medication management, meditation, and mindfulness support, while its clinicians use digital tools and research-backed approaches to raise care quality and grow strong practices. The company emphasizes a combination of technology and human connection to improve outcomes.

The organization also expects team members to use modern AI tools as part of their daily work and to keep adapting as new platforms emerge. Familiarity with tools such as Gemini, ChatGPT, Claude, GitHub Copilot, or similar AI productivity tools is considered an important part of success in the role.

Role overview

The Clinical Quality Specialist, Utilization Management position is responsible for protecting clinical quality and integrity across the organization, with particular focus on utilization management, payor-facing audits, and clinical quality assurance. The role helps ensure care is medically appropriate, clearly documented, aligned with evidence-based standards, and compliant with payer expectations. It also supports providers by balancing clinical judgment with review rigor and audit readiness.

Key responsibilities

This role acts as an important connector between clinical care, payer requirements, and internal quality expectations. It involves review work, provider support, reporting, and continuous improvement.

• Perform prospective, concurrent, and retrospective utilization reviews to evaluate medical necessity, treatment fit, and level of care.
• Use evidence-based utilization management criteria to assess documentation and support authorization and appeal activities.
• Track care intensity and utilization patterns to identify exceptions and guide focused provider outreach.
• Coordinate with health plans on external utilization review requests and peer-to-peer review processes.
• Address provider issues that arise from utilization findings, client complaints, or outside reports, and work toward remediation.
• Monitor clinical adverse events and help apply early risk-mitigation actions with cross-functional partners.
• Support measurement-based care initiatives and look for opportunities to improve outcomes across the provider network.
• Maintain utilization metrics, review counts, and case results to support quality-improvement work.
• Highlight workflow gaps and emerging trends for leadership, and help refine utilization management policies and processes.

What success in this role looks like

• Reviews are completed accurately, within required timelines, and in line with payer and regulatory expectations.
• Utilization findings lead to practical provider support plans and measurable improvement in care appropriateness.
• Cases are handled independently with strong clinical judgment, complete documentation, and limited supervision.
• Internal partners view you as a dependable, solution-focused collaborator on quality and utilization topics.
• Provider relationships remain constructive and trust-based, even during remediation efforts.
• You identify broader utilization trends early and share improvement ideas with leadership.

Candidate profile

The ideal candidate has a master’s degree in a mental health field and an active, clear clinical license in good standing, such as LMFT, LPC, LCSW, LMHC, or an equivalent credential. Prior experience in utilization management, utilization review, medical necessity review, or clinical auditing is preferred, especially in behavioral health or within a payer/health plan environment.

Strong familiarity with payer rules, medical necessity standards, and level-of-care guidelines is important, along with the ability to manage escalations, adverse events, and quality-related investigations. The role also calls for clear, defensible clinical documentation, strong cross-functional collaboration, commitment to provider support, and comfort using clinical technology platforms for documentation, case management, and data analysis.

Benefits

SonderMind offers a benefits package designed to support employee wellbeing and professional growth.

• Generous paid time off, including at least three weeks of annual leave.
• Paid holidays that align 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; the HSA includes a $1,100 company contribution.
• Company-paid short-term disability, long-term disability, life insurance, and AD&D coverage, plus salary-difference coverage for up to seven weeks of short-term disability leave after the waiting period.
• Eight weeks of paid parental leave, with total paid leave potentially reaching 8–16 weeks if the parent also qualifies for short-term disability.
• 401(k) plan with a 100% match on contributions up to 4% of base salary, vested immediately.
• Annual company gathering with teammates from across the country.
• Company shutdown between Christmas and New Year’s.
• Supplemental life insurance, pet insurance, commuter benefits, and additional perks.

Additional information

This opening is being recruited on an ongoing basis and will remain available until filled.

Equal opportunity

The employer provides equal employment opportunity and does not discriminate 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 status.