Clinical Quality Specialist

About SonderMind At SonderMind, we believe everyone deserves a personalized, connected, and effective mental health destination to take care of their mental health and well‑being at any stage of life. We provide therapy, medication management, and mindfulness exercises, leveraging digital tools and research to deliver high‑quality care. About the Role The Clinical Quality Specialist is a critical driver of care integrity at SonderMind, focusing on utilization management and clinical review. This role ensures the right care is delivered at the appropriate intensity and duration, supporting client outcomes and the sustainability of our provider network. What you’ll do Utilization Management & Review Conduct prospective, concurrent, and retrospective utilization reviews to assess medical necessity, treatment appropriateness, and level of care. Apply evidence‑based criteria to evaluate clinical documentation and support authorization and appeal processes. Monitor care intensity and utilization trends to identify outliers and inform targeted provider interventions. Partner with health plans on external review requests and peer‑to‑peer review coordination. Clinical Quality & Provider Support Investigate and remediate provider concerns stemming from UM findings, client complaints, or external reports. Monitor clinical adverse events and apply early‑stage risk mitigation in partnership with cross‑functional teams. Support measurement‑based care initiatives and identify opportunities to strengthen clinical outcomes across the provider network. Reporting & Continuous Improvement Track utilization metrics, review volumes, and case outcomes to inform quality improvement efforts. Surface trends and process gaps to leadership, contributing to the ongoing refinement of UM policies and workflows. What does success look like? Utilization reviews are completed accurately, on time, and in compliance with payer and regulatory requirements. UM findings translate into actionable provider support plans and measurable improvement in care appropriateness. Cases are managed independently with sound clinical reasoning, thorough documentation, and minimal oversight. Cross‑functional partners rely on you as a knowledgeable, solutions‑oriented collaborator on UM and quality matters. Provider relationships remain trust‑based and constructive, even through remediation processes. You proactively identify systemic utilization trends and bring improvement recommendations to leadership. Who You Are Master’s degree in a mental health discipline. Active, cleared clinical license (e.g., LMFT, LPC, LCSW, LMHC, or equivalent) in good standing. Strong clinical judgment and experience handling escalations, adverse events, or quality‑related investigations. Demonstrated ability to collaborate effectively across multiple teams. Commitment to provider support and quality management. Familiarity with clinical technology platforms for documentation, case tracking, and data analysis to support provider quality and compliance. Our Benefits Salary range: $72,000 – $82,000 . Final compensation will be determined based on relevant experience, skills, education, and performance. This position is also eligible for equity. A generous PTO policy, with a minimum of three weeks off per year. A holiday schedule that follows standard U.S. holidays. Free therapy coverage benefits to ensure employees have access to care (must be enrolled in a qualifying medical plan to participate). Competitive medical, dental, and vision coverage, with HSA (company contribution $1,100) and FSA options. Employer‑paid short‑term and long‑term disability, life & AD&D, plus salary difference coverage for up to seven weeks of short‑term disability leave (after required waiting period). Eight weeks of paid parental leave; additional 8–16 weeks if also qualifying for STD. 401(k) retirement plan with 100% match on up to 4% of base salary, immediately vested. Annual company gathering with teammates nationwide. Company shutdown between Christmas and New Year’s. Supplemental life insurance, pet insurance, commuter benefits, and more. Application Deadline This position will be an ongoing recruitment process and will be open until filled. Equal Opportunity SonderMind does not discriminate in employment opportunities or practices based on race, color, creed, sex, gender, gender identity or expression, pregnancy, childbirth or related medical conditions, religion, veteran and 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 characteristic protected by applicable federal, state, or local laws. #J-18808-Ljbffr