Legal Specialist (On-site)

Our Mission

We are driven by a shared mission to improve the quality of life for all people we serve. This mission guides every aspect of our work and is embedded into the fabric of our daily operations, leadership, and service delivery.

Job Summary:

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.

Essential Job Functions:

• 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

Knowledge and Abilities:

• Strong research and statutory interpretation skills
• Excellent written and verbal communication skills
• High attention to detail and ability to manage multiple deadlines simultaneously
• 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

Education and Experience:

• Minimum of 3 years of experience regulatory change management, or legal role or a role with similar, transferable skills
• Bachelor’s Degree is required
• Paralegal, project management or other advanced certification preferred
• Willing to obtain various legal or compliance-based certifications within the industry

Position Demands:

This position requires sitting, bending, and stooping for up to 8 hours per day in an office setting. Ability to lift and move objects weighing up to 10 lbs. Ability to learn technical material. The person in this position needs to occasionally move about inside the office to access file cabinets, office machinery, etc. Must be able to operate a computer and other office productivity machinery such as a calculator, copy machine, printer, etc. The person in this position frequently communicates with guests, employees, and vendors and must be able to exchange accurate information.

Equal Employment Opportunity (Our EEO Statement):

The Company is a veteran-owned Company and provides Equal Employment Opportunities (EEO) to all Team Members and applicants for employment without regard to race, color, religion, sex, sexual orientation, gender (including gender identity), pregnancy, childbirth, or a medical condition related to pregnancy or childbirth, national origin, age, disability, genetic information, status as a covered veteran in accordance with applicable federal, state, and local laws, or any other characteristic or class protected by law and is committed to providing equal employment opportunities. The Company complies with applicable state and local laws governing non-discrimination in employment. This policy applies to all terms and conditions of employment, including, but not limited to, hiring, promotion, discharge, pay, fringe benefits, membership, job training, classification, and other aspects of employment. Team Members who believe they are the victims of discrimination should immediately report the concern to their Supervisor and the Human Resources Department. Discrimination and harassment will not be tolerated.

We are committed to creating an inclusive environment for all Team Members and applicants. We value the unique skills and experiences that veterans bring to our team and encourage veterans to apply.

Disclaimer:

The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all responsibilities, duties, and skills required of our personnel. All team members may be required to perform duties outside of their normal responsibilities from time to time, as needed.

Nexus Enterprises, LLC is an MRG entity