Quality Program Specialist

Quality Program Specialist

Paradigm is an accountable specialty care management organization focused on improving the lives of people with complex injuries and diagnoses. The company has been a pioneer in value-based care since 1991 and has an exceptional track record of generating the very best outcomes for patients, payers, and providers. Deep clinical expertise is the foundation for every part of Paradigm's business: risk-based clinical solutions, case management, specialty networks, home health, shared decision support, and payment integrity programs.

Paradigm is seeking a full-time Quality Program Specialist in the Tampa, FL, area. The position would be mostly remote, but require going into the office periodically for meetings, trainings, etc.

The Quality Program Specialist is responsible for ensuring quality standards are compliant with customer requirements and consistent with company standards through quality audit processes and regular reporting. This role supports quality assurance through triage, escalation management, cause analysis, and collaboration with cross-functional teams. The specialist will lead monthly reporting of KPIs, document findings, and contribute to continuous process improvement initiatives. The ideal candidate will have strong analytical skills, a background in healthcare or workers' compensation, and experience in quality management and operational problem-solving.

• Quality Assurance and Input Management
  • Perform quality audits on processes.
  • Triage issues to appropriate teams based on complexity and urgency.
  • Ensure consistent and accurate documentation and process execution.
• Escalation and Problem Solving
  • Manage and track escalated issues, ensuring timely resolution and stakeholder communication.
  • Collaborate with internal departments (e.g. Referral Management, Network development, Network Billing, Account Management, Network Services, IT) to resolve complex problems.
  • Act as a liaison between internal teams and external when needed.
• Root Cause Analysis and Continuous Improvement
  • Conduct monthly root cause analysis of recurring issues and escalations.
  • Identify patterns and trends to inform management.
  • Recommend and support implementation of corrective actions and preventive measures.
• Reporting and Documentation
  • Develop and maintain reports for KPIs, audit results, and process metrics.
  • Present findings to management and contribute to continuous improvement.
  • Maintain documentation of audit, procedures, training materials, and process workflows.
  • Maintain reliable and predictable attendance during scheduled work hours.
  • Comply with Paradigm Information Security requirements and policies, for safeguarding Paradigm or Paradigm related passwords, and for notifying Paradigm of any Information Security incidents per policy SEC 10-12 Information Security Incident Management.
  • Demonstrate a customer-first mindset by developing a broad and deep (where appropriate) understanding of Paradigm organization, products, operations, and customers. Prioritize collaboration to meet customer needs and expectations and take personal accountability for service quality.
  • Utilize AI tools to support day-to-day tasks, improve efficiency, and enhance output quality. Adopt new technologies as trained and apply them in alignment with established processes and guidelines.

• Bachelor's degree or equivalent work experience.
• 2–4 years of experience in process improvement, operations analysis, or quality improvement.
• Strong analytical and problem-solving skills.
• Proficiency in MS Office, especially Excel (pivot tables, charts, formulas).
• Excellent written and verbal communication skills.
• Ability to work independently and manage multiple priorities.
• Preferred:
  • Experience in healthcare, workers' compensation, or bill review operations.
  • Familiarity with quality management tools (e.g., root cause analysis, PDCA, Pareto charts).
  • Certification in Six Sigma, Lean, or ASQ.

Paradigm Benefits:

• Health and wellness – We want our people to be and stay healthy, so we offer PPO, HDHP, and HMO health insurance options with Cigna and Kaiser (CA employees only).
• Financial incentives – Paradigm's…