Clinical Network Regulatory Specialist at Paradigm – Walnut Creek, California

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.

Paradigm is seeking a full-time, remote Clinical Network Regulatory Specialist. The primary purpose of the Clinical Network Regulatory Specialist is to provide support for the Paradigm Clinical Resource Operations business unit to ensure efficient and compliant business processes. The positions support compliance of the clinical risk network and field case management, telephonic and vocational clinicians. This position requires excellent attention to detail, timeliness, problem-solving, analytics and decision-making skills.

Key Responsibilities:

• Support Clinical Resource Operations and Case Management by interpreting regulatory requirements and advising leaders on compliant documentation, processes, and workflows.
• Manage assigned state and client reporting requirements, ensuring accurate data validation, trend analysis, and identification of compliance risks.
• Administer clinical compliance communications by triaging regulatory, licensing, and credentialing inquiries and tracking actions through resolution.
• Perform primary license and credential verification for clinical resources, resolve discrepancies, and escalate potential compliance issues as needed.
• Maintain credentialing and compliance documentation across systems to support audits and ongoing regulatory requirements.
• Serve as site administrator for license verification systems and oversee verification workflows and recordkeeping.
• Monitor onboarding and credentialing progress, identify gaps or delays, and coordinate corrective actions with stakeholders.
• Conduct periodic compliance and credentialing audits, document findings, and track corrective actions to completion.
• Develop and analyze compliance and credentialing reports to identify trends, exceptions, and opportunities for process improvement.
• Contribute to cross‑functional compliance, credentialing, and onboarding initiatives while promoting efficiency, risk mitigation, and continuous improvement.

Qualifications:

• Bachelor’s Degree or equivalent experience
• Excellent computer skills, including knowledge of current Microsoft operating system and Microsoft Office products.
• Knowledge of or ability to learn proprietary company case management software. Decision making and critical thinking skills.
• Problem solving and conflict resolution. Ability to prioritize and multi-task.
• Ability to work under pressure and meet deadlines.
• Proven interpersonal and leadership skills.
• Excellent written and verbal communication. Ability to function as a member of a team. Ability to work with little supervision.
• Excellent attention to detail.