Legal Specialist (On-site)
About The Position
We are seeking a detail-oriented, highly organized Legal Specialist with a strong legal background and related compliance frameworks. Specific knowledge of workers’ compensation laws, Utilization Review (UR) regulations, and related compliance frameworks are strongly preferred. This role will serve as a member of our compliance team and will also provide support for our operations and clinical review teams by monitoring regulatory changes, assisting with legal research, preparing documentation, and ensuring adherence to state and federal UR standards. This position also ensures our organization remains compliant and well-prepared within a highly regulated environment. The ideal candidate will combine legal expertise with an operational mindset to support efficient and compliant Utilization Review processes.
Requirements
- Strong research and statutory interpretation skills
- Excellent written and verbal communication skills
- High attention to detail and ability to manage multiple deadlines simultaneously
- Minimum of 3 years of experience regulatory change management, or legal role or a role with similar, transferable skills
- Bachelor’s Degree is required
Nice To Haves
- Experience in healthcare, insurance, workers’ compensation, or managed care industries is strongly preferred
- Working knowledge of workers’ compensation law and/or utilization review regulations (any state, preferably multi-state) are strongly preferred
- Familiarity with UR processes, including medical necessity review, timeframes, appeals, and reporting requirements are strongly preferred
- Experience with URAC requirements or state-specific UR licensure processes are strongly preferred
- Paralegal, project management or other advanced certification preferred
- Willing to obtain various legal or compliance-based certifications within the industry
Responsibilities
- Research, track, and interpret changes to workers’ compensation statutes, UR regulations, and administrative rules across applicable jurisdictions
- Review regulatory filings, notices, and UR determination templates, ensuring accuracy and compliance with state rules
- Conduct legal research on workers’ compensation case law, UR appeals, independent medical review (IMR) requirements, and state-specific medical treatment guidelines
- Summarize findings for leadership and clinical teams to support decision-making
- Analyze complex regulatory language and provide written interpretations for team members
- Assist in maintaining organizational compliance with state-specific requirements, UR requirements, licensing obligations, timelines, and notice requirements
- Provide support for state UR licensure applications, renewals, annual reports and supporting materials
- Support internal audits to ensure alignment with regulatory frameworks and accreditation standards (e.g., URAC, state UR registrations)
- Draft, update, and review compliance policies, SOPs, training materials, and other supporting reference documents
- Support responses to state inquiries, records requests, and compliance investigations
- Provide compliance guidance during process improvements, system updates, and new business initiatives
- Provide organization-wide advisory support on compliance, ensuring best practices and alignment with company goals
- Participates in training sessions for team members
- Provide input for the Compliance department’s work plan
- Promote adherence to the organization's compliance program
- Provide support for ad hoc projects, assignments and other initiatives as needed
- Other duties as assigned by Director, Compliance or SVP, Compliance
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Number of Employees
1-10 employees
