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.

We're proud to be recognized—again! For the fourth year in a row, we've been certified by Great Place to Work®, and for the third consecutive year, we've earned a spot on Fortune's Best Workplaces in Health Care™ list. These honors reflect our unwavering commitment to fostering a positive, inclusive, and employee-centric culture where people thrive.

Watch this short video for a brief introduction to Paradigm.

We are seeking a full-time Quality Program Specialist. This position will be hybrid in the Tampa area. 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.

RESPONSIBILITIES:

Quality Assurance & Input Management

• Perform quality audits on processes.
• Triage issues to appropriate teams based on complexity and urgency.
• Ensure consistent and accurate documentation & Process execution.

Escalation & 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 & 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 & 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.

Compliance & Security

• Ensure adherence to company policies, regulatory requirements, and IT security protocols.
• Safeguard confidential information and report any security incidents per policy.

QUALIFICATIONS:

• Bachelor's degree or equivalent work experience.
• 24 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.