Your all-in-one wellness solution that connects you to affordable, quality mental healthcare
Clinical Quality Specialist
Location
Colorado
Posted
3 days ago
Salary
$72K - $82K / year
Seniority
Senior
Job Description
Clinical Quality Specialist
SonderMind
• 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
Job 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
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