Clinical Quality Specialist

About SonderMind At SonderMind, we believe everyone deserves a personalized, connected, and effective mental health destination to care for their well‑being at any stage of life. About The Role The Clinical Quality Specialist is a critical driver of care integrity at SonderMind, with a primary focus on utilization management and clinical review. This role ensures that the right care is delivered at the right intensity for the right 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 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 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 The anticipated salary range for this role is $72,000 - $82,000. Final compensation will be determined based on relevant experience, skills, education, and past performance. In addition to base salary, this position is eligible for equity. Our benefits include: 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 the care they need (must be enrolled in a qualifying medical plan to participate) Competitive Medical, Dental, and Vision coverage, including HSA ($1,100 company contribution) and FSA options Employer‑paid short‑term disability, long‑term disability, life & AD&D, plus coverage of the salary difference for up to seven weeks of short‑term disability leave (after the required waiting period) Eight weeks of paid parental leave (and up to 16 weeks if qualifying for short‑term disability) 401(k) retirement plan with 100% match on up to 4% of base salary, immediately vested Annual company gathering that brings teammates from across the country together 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 remain 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 SonderMind