Clinical Quality Specialist
Listed on 2026-07-05
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Business
Regulatory Compliance Specialist
About Sonder Mind
At Sonder Mind, 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. Sonder Mind 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, Sonder Mind drives better outcomes through our comprehensive approach. Learn more about Sonder Mind at or download the mobile app, available on iOS and Android. To follow the latest Sonder Mind news, get to know our clients, and learn about what it’s like to work at Sonder Mind, you can follow us on Instagram, Linkedin, and Twitter.
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 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.
What You’ll Do Utilization Management & Review- 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
- Utilization reviews are completed accurately, on time, and in compliance with payer and regulatory requirements
- UM findings translate into actionable provider support plans and measurable improvement in care appropriateness
- Cases are managed independently with sound clinical reasoning, thorough documentation, and minimal oversight
- Cross‑functional partners rely on you as a knowledgeable, solutions‑oriented collaborator on UM and quality matters
- Provider relationships remain trust‑based and constructive, even through remediation processes
- You proactively identify systemic utilization trends and bring improvement recommendations to leadership
- 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…
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