Clinical Quality Specialist

SonderMind • Denver, CO

2d

About The Position

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.

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.

Requirements

• 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.

Nice To Haves

• 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

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

What This Job Offers

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