Quality Program Specialist

About Paradigm 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. Role Overview Paradigm is seeking a full‑time Quality Program Specialist in the Tampa, FL area. The position would be mostly remote but requires periodic office visits for meetings, trainings, and other business needs. The Quality Program Specialist is responsible for ensuring quality standards comply with customer requirements and are consistent with company standards through 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 KPI reporting, 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. Duties & Responsibilities 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 (Referral Management, Network Development, Network Billing, Account Management, Network Services, IT) to resolve complex problems. Act as a liaison between internal teams and external parties 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 audits, procedures, training materials, and process workflows. Maintain reliable and predictable attendance during scheduled work hours. Ensure compliance with Paradigm Information Security requirements and policies, safeguard passwords, and report security incidents per policy SEC 10‑12 Information Security Incident Management. Demonstrate a customer‑first mindset by developing a broad and deep understanding of Paradigm’s 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. Qualifications 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 (root cause analysis, PDCA, Pareto charts). Certification in Six Sigma, Lean, or ASQ. Benefits Health and wellness: PPO, HDHP, and HMO health insurance options with Cigna and Kaiser (CA employees only). Financial incentives: competitive salaries, 401(k) matching contributions, employer‑paid life and disability insurance, flexible spending and commuter accounts, and employer‑matched HSA contributions. Vacation: paid time off and personal holiday programs. Volunteer time: one paid day per calendar year. Learning and development: Learning Excellence at Paradigm (LEAP) program. Equal Opportunity & Accommodations Paradigm believes that fostering a diverse and inclusive workplace is central to our mission of helping more people and transforming lives. We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. Paradigm complies with federal and state disability laws and makes reasonable accommodations for applicants and employees with disabilities. If reasonable accommodation is needed to participate in the job application or interview process, to perform essential job functions, and/or to receive other benefits and privileges of employment, please contact Leave Management at View email address on click.appcast.io. #J-18808-Ljbffr Paradigm