Behavioral Health Compliance Manager

Behavioral Health Compliance Manager

Location: 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.

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.

How You Will Make an Impact

• 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.

Minimum 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.

Preferred Skills, Capabilities, & Experiences:

• 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.

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Who We Are

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

How We Work

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process may contact [email protected] for assistance.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.