Clinical Quality Specialist

Clinical Quality Specialist ABOUT SONDERMIND At SonderMind, we believe everyone deserves one personalized, connected, and effective mental health destination to take care of their mental health and well-being at any stage of life. SonderMind care encompasses everything from therapy and medication management to meditation and mindfulness exercises. Our clinicians leverage our digital tools and research to deliver increasingly high-quality care and to develop thriving practices. Combining technology and human connection, SonderMind drives better outcomes through our comprehensive approach. Learn more about SonderMind at sondermind.com or download the mobile app, available on iOS and Android. To follow the latest SonderMind news, get to know our clients, and learn about what it’s like to work at SonderMind, you can follow us on Instagram https://www.instagram.com/sondermind/?hl=en, Linkedin https://www.linkedin.com/company/sondermind/, and Twitter https://twitter.com/SonderMind?ref_src=twsrc%5Egoogle%7Ctwcamp%5Eserp%7Ctwgr%5Eauthor. Additionally, we expect all team members to effectively leverage modern AI technologies as part of their everyday workflow, and to continuously adapt as new tools emerge. Familiarity with job-relevant AI platforms such as Gemini, ChatGPT, Claude, GitHub Copilot or other industry-standard AI productivity tools is expected and considered essential for success at this company. 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 both client outcomes and the sustainability of our provider network. You will lead utilization review activities, apply evidence-based criteria to clinical cases, and partner cross-functionally to strengthen the quality and appropriateness of care across SonderMind's platform. 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) i ... (truncated, view full listing at source)