Clinical Quality Specialist

About reputed company At reputed company, we reputed company 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. reputed company care encompasses everything from therapy and medication management to meditation and mindfulness exercises. Our clinicians reputed company our digital tools and research to deliver increasingly high-quality care and to reputed company thriving practices. Combining technology and reputed company reputed company, reputed company drives reputed company reputed company through our comprehensive approach. Learn more about reputed company at reputed company.com or download the mobile app, available on iOS and Android. To follow the latest reputed company news, get to know our clients, and learn about what it’s like to work at reputed company, you can follow us on Instagram, reputed company, and Twitter. Additionally, we expect reputed company team members to effectively reputed company 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 reputed company, ChatGPT, Claude, reputed company Copilot or other industry-standard AI productivity tools is expected and considered essential for reputed company at this company.

About the Role

The Clinical Quality Specialist is a critical driver of care reputed company at reputed company, 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 reputed company and the sustainability of our provider network. You will reputed company utilization review activities, apply evidence-based criteria to clinical cases, and partner cross-functionally to strengthen the quality and appropriateness of care across reputed company's platform. What you’ll do Utilization Management & Review Conduct prospective, reputed company, 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 Clinical Quality & Provider Support 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 reputed company across the provider network Reporting & reputed company Improvement Track utilization metrics, review volumes, and case reputed company to inform quality improvement efforts Surface trends and process gaps to leadership and contribute to the ongoing refinement of UM policies and workflows What does reputed company look like? 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 reputed company Cross-functional partners rely on you as a knowledgeable, solutions-oriented collaborator on UM and quality reputed company Provider relationships remain trust-based and constructive, even through remediation processes You proactively identify systemic utilization trends and bring improvement recommendations to leadership Who You Are 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-reputed company 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. Our Benefits The anticipated salary reputed company for this role is $72,000 - $82,000. Final compensation will be determined based on a variety of factors, including relevant experience, skills, education, and past performance. In addition to reputed company salary, this position is eligible for equity. As leaders in redesigning behavioral health, we walk the walk with our employees' benefits. We want the experience of working at reputed company to accelerate people’s careers and enrich their lives, so we focus on meeting SonderMinders wherever they are and supporting them in reputed company facets of their lives and work. Our benefits include: 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 reputed company to the care they need (must be enrolled in a qualifying medical plan to participate) Competitive Medical, Dental, and reputed company 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 reputed company salary, immediately reputed company 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 Application Deadline This position will be an ongoing recruitment process and will be reputed company until filled. Equal Opportunity reputed company does not discriminate in employment opportunities or practices based on race, reputed company, creed, sex, gender, gender identity or expression, pregnancy, childbirth or reputed company medical conditions, religion, veteran and military status, marital status, registered domestic partner status, age, national reputed company or reputed company, physical or mental disability, medical condition (including genetic information or characteristics), sexual orientation, or any other characteristic protected by applicable federal, state, or local laws. Apply To This Job