Behavioral Health Compliance Manager

Elevance Health•Nashville, TN

1d•Hybrid

About The Position

The Behavioral Health Compliance Manager is responsible for supporting all lines of business by providing advanced regulatory, clinical, and operational compliance expertise. This role serves as a key subject matter expert (SME) in behavioral health, combining compliance knowledge with clinical insight to interpret complex regulatory requirements, assess business impact, and guide implementation. This role requires strong collaboration across internal teams and external partners, including health plan compliance organizations, to ensure aligned, practical, and compliant solutions. This role requires associates to be in-office 1 - 2 days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

Requirements

Requires a BA/BS and minimum of 6 years health care, regulatory, ethics, compliance or privacy experience; or any combination of education and experience, which would provide an equivalent background.
Ability to travel may be required.

Nice To Haves

Strong knowledge of behavioral health operations and clinical concepts (e.g., levels of care, utilization management).
Demonstrated experience interpreting and applying healthcare regulations.
Ability to conduct complex regulatory research and translate into actionable compliance guidance.
Clinical background or licensure (e.g., LCSW, LPC, LMFT, RN, or similar) strongly preferred.
Advanced degree (MS, MBA, JD) or relevant certification (e.g., CHC, CHPC).
Experience working with health plans and behavioral health organizations, including Medicare/Medicaid.

Responsibilities

Support regulatory audits/exams, internal audits.
Conduct mock audits, audit training, and oversee audit evidence preparation.
Assess audit readiness, identify gaps, and guide development of remediation strategies.
Perform risk assessments and support mitigation planning across behavioral health operations.
Establish project plans, gap analysis, milestone dates, and other significant aspects, and leadership updates.
Provide compliance input into new and evolving program initiatives, including new concepts, regulatory questions, and business models.
Evaluate compliance implications and risks, ensuring alignment with regulatory expectations.
Serve as a behavioral health compliance SME, providing clear, actionable guidance on regulatory requirements across lines of business.
Conduct complex research and in-depth analysis of federal and state regulations, translating findings into practical compliance recommendations.
Apply knowledge of behavioral health practices (e.g., levels of care, utilization management, treatment models) to inform regulatory interpretation and risk identification.
Partner with internal stakeholders and health plan compliance teams to align on regulatory interpretation and implementation.
Lead complex compliance investigations, including those involving behavioral health considerations.
Document findings, perform root cause analysis, and ensure appropriate corrective actions are implemented.