SonderMind
Healthcare
ClinicalQualitySpecialist
Neural analysis suggests this role is
optimal for Mid+ candidates.
“Clinical Quality Specialist at SonderMind. Skills: Utilization management, Clinical quality assurance, Provider support. Conduct utilization reviews. Assess medical necessity”
What You'll Achieve.
Accurate utilization reviews; Timely utilization reviews; Compliant utilization reviews; Actionable provider support plans; Measurable care appropriateness improvement; Independent case management; Thorough documentation; Minimal oversight; Solutions-oriented collaborator; Trust-based provider relationships; Constructive provider relationships; Proactive utilization trend identification; Improvement recommendations to leadership
Industry & Context.
Sound clinical reasoning
What They're Looking For.
Must Have
Master's degree in mental health, Active clinical license in good standing, Experience in utilization management, Familiarity with payor requirements, Clinical judgment and experience, Produce clear, accurate documentation, Collaborate effectively across teams, Commitment to provider support
Nice to Have
Behavioral health utilization management, Payor/health plan context experience, Familiarity with AI platforms
What You'll Do.
Conduct utilization reviews
Assess medical necessity
Evaluate clinical documentation
Support authorization processes
Support appeal processes
Monitor care intensity trends
Identify utilization outliers
Inform provider interventions
Partner with health plans
Coordinate peer-to-peer review
Investigate provider concerns
Remediate provider concerns
Monitor clinical adverse events
Apply risk mitigation
Support measurement-based care
Identify outcome improvement opportunities
Track utilization metrics
Surface trends to leadership
Surface process gaps to leadership
How You'll Work.
Team & Collaboration
Cross-functional teams; Health plans; Provider network
Full Job Description
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, Utilization Management 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 wi
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