Part-Time Clinical Quality Specialist

Part-Time Clinical Quality Specialist

The Part-Time Clinical Quality Specialist role exists to safeguard and strengthen the clinical integrity of care delivered across the organization, with a focused lens on utilization management, payor-facing clinical audits, and clinical quality assurance. This position ensures that care is medically necessary, appropriately documented, and aligned with evidence-based standards and payor requirements supporting both provider success and defensible, compliant clinical operations.

This is a collaborative, provider-supportive role that combines sound clinical judgment with the rigor of utilization review and audit-readiness. The Specialist serves as a key bridge between clinical care, payor expectations, and internal quality standards.

This is a part-time position, up to 30 hours per week.

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 UM 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 UR 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 and contribute 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.
• Experience in utilization management, utilization review, medical necessity review, or clinical auditing ideally in a behavioral health or payor/health plan context.
• Familiarity with payor requirements, medical necessity criteria, and level-of-care guidelines.
• Strong clinical judgment and experience handling escalations, adverse events, or quality-related investigations.
• Demonstrated ability to produce clear, accurate, and defensible clinical documentation.
• 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.

Compensation Range

The hourly rate offered for this role is between $40.00-$42.00/hour, up to 30 hours per week.

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.