Clinical Quality Specialist

🔥 13 minutes ago

⛰️ Colorado – Remote

⛰️ Colorado – Remote

💵 $72k - $82k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

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SonderMind

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 2014

🧘 Wellness

☁️ SaaS

👥 B2C

💰 $150M Series C - SonderMind on 2021-07

Wellness • SaaS • B2C

SonderMind is a national mental health company that connects people with therapy and psychiatry services through a consumer-facing platform and mobile app. It matches clients to licensed providers, supports scheduling and insurance billing, and offers measurement-based care and self-guided resources. SonderMind also provides tools and practice management support for clinicians and partners with health systems, payors, and other organizations to integrate mental healthcare.

📋 Description

• 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 • 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 • 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

🎯 Requirements

• 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.

🏖️ Benefits

• 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, with plans to meet every need — including HSA (with $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; if the parent also qualifies for STD, this benefit is in addition, allowing for 8–16 weeks of paid leave • 401(k) retirement plan with 100% match on up to 4% of base salary, immediately vested • Join teammates from across the country at our annual company gathering • Company shutdown between Christmas and New Year’s • Supplemental life insurance, pet insurance, commuter benefits, and more