Job Summary

The Clinical Compliance Manager is responsible for ensuring that behavioral health services comply with all applicable federal, state, and payer regulations. This role oversees clinical documentation standards, compliance audits and regulatory training to support quality care and organizational integrity. The position works closely with clinical leadership to ensure services meet regulatory requirements such as HIPAA, Medicaid, and other payer guidelines.

Key Responsibilities

• Develop, implement, and monitor clinical compliance policies and procedures.

• Ensure compliance with federal, state, and payer regulations in behavioral health services.

• Conduct internal audits of clinical documentation, billing practices, and service delivery.

• Review treatment documentation to ensure it meets Medicaid, Medicare, and insurance standards.

• Identify compliance risks and develop corrective action plans.

• Serve as the primary contact during regulatory or payer audits.

• Provide compliance training and education to clinical and administrative staff.

• Maintain up-to-date knowledge of behavioral health regulations and best practices.

• Collaborate with clinical leadership on quality improvement initiatives.

• Prepare compliance reports for executive leadership.

Required Qualifications

• Bachelor’s or Master’s degree in Healthcare Administration, Social Work, Psychology, Public Health, or related field.

• 3+ years of experience in healthcare or behavioral health compliance.

• Strong knowledge of:

  • Behavioral health regulations

  • Clinical documentation standards

  • Medicaid/Medicare billing compliance

  • Healthcare privacy laws (HIPAA)

• Experience conducting internal audits and compliance investigations.

• Strong analytical, communication, and organizational skills.

Preferred Qualifications

• Licensed behavioral health professional (LSW, LPC, LMFT, etc.)

• Experience working with community mental health or substance use programs.

Location: On Site/Flexible Schedule
Job Type: Full-time