Part-Time Clinical Quality Specialist

SonderMind • Denver, CO

8d • $40 - $42

About The Position

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.

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.
• Familiarity with 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.

Responsibilities

• 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

What This Job Offers

• Job Type: Part-time
• Career Level: Mid Level