DIRECTOR OF APPEALS AND COMMUNITY RESOLUTIONSSupervisionReceives general supervision from the Executive Director.The Position and Job SummaryThe Director of Appeals and Community Resolutions leads a department with multiple teams which include Appeals and Grievance Resolution. The Director delegates daily team operations and routine case management to the respective managers, develops their leadership capabilities, and holds them accountable for timely, fair, accessible, and person-centered outcomes. The Director establishes department priorities, operating standards, staffing and resource plans, and performance expectations while maintaining oversight of both teams.
The Director provides guidance and direction on challenging, sensitive, or unresolved grievance and appeal cases when needed. This position requires working collaboratively with other members of senior leadership. This position may require participation in internal committees and external entities such as the Department of Developmental Services "DDS". The Director analyses data, identifies trends and monitors evolving state-level policies, guidance, and system change to develop and implement targeted staff training that supports compliance, strengthens operational effectiveness, and ensures staff remain informed and equipped to respond to emerging requirements. The director will also develop and present proposals to the Executive leadership Team "ELT" for consideration, strategic alignment, and approval, as appropriate.
Department leadership and delegation- Direct operations through the department's managers. Delegate routine case assignment, staff supervision, workload distribution, deadline tracking, case documentation, and day-to-day follow-up to the managers, while retaining accountability for department performance.
- Train, coach, and evaluate managers; build their capacity to make decisions, supervise staff, manage complex workloads, assess case quality, and resolve operational issues. Establish clear decision authority and criteria for escalation to the Director.
- Set department priorities, staffing plans, budgets, quality standards, and performance measures. Review managers' reports on caseloads, case aging, capacity, and deadline risks; address systemic barriers and recommend resource changes.
- Direct managers to develop and maintain procedures, coverage plans, and quality review practices. Approve substantive changes and ensure consistent implementation across teams.
Appeals oversight- Oversee the Appeal Manager's administration of existing service and eligibility appeal processes, including informal meetings, mediation, hearing preparation, representation, coordination with legal counsel, and implementation of appeal outcomes.
- Hold the Appeals Manager accountable for applicable notices, filing and response deadlines, accurate case records, continuation of services when required, and timely completion of decisions and settlements. Review exceptions, recurring deficiencies, and escalated matters.
- Ensure the Appeals Manager maintains distinct procedures for Early Start complaints, mediation, and due process, and other assigned administrative or provider appeals under their applicable requirements.
Grievance resolution oversight- Lead implementation and ongoing oversight of the DDS grievance framework. Delegate referral intake, reviewer assignment, routine review and communication, case file access, resolution plan preparation, reporting, and implementation tracking to the Grievance Resolution Manager and team.
- Hold the Grievance Resolution Manager accountable for timely, accessible, person-centered reviews and resolution plans that address the concern and prevent recurrence when appropriate. Ensure factual and rights-related concerns are considered without making substantiation of a rights violation the sole measure of resolution.
- Ensure the manager assigns qualified reviewers who meet applicable independence requirements and maintains appropriate consent, authorization, confidentiality, and participation practices. Establish alternate review pathways when a department or leadership conflict arises.
- Review performance and exceptions relating to disclosure, resolution, extensions, state-level review, and corrective action requirements. Ensure managers escalate urgent safety concerns, retaliation allegations, missed deadlines, and barriers to implementation through the appropriate pathways.
- Ensure managers coordinate matters involving both appeals and grievance issues without delaying access to either process, and maintain appropriate handling of complaints filed under the prior framework during the transition.
Direct leadership on challenging cases- Assume direct responsibility, when needed, for the most challenging grievance and appeal cases, including prolonged disputes, significant health or safety concerns, complex legal or factual issues, multiple department involvement, or cases that managers have been unable to resolve.
- Determine the level of Director involvement appropriate to each escalated case. Lead case conferences, engage individuals and authorized representatives, coordinate with Case Management and legal counsel, and participate in resolution discussions, mediation, or hearings as needed within delegated authority.
- For grievances requiring the Director's direct involvement, preserve reviewer independence and arrange an alternate reviewer when the Director is ineligible to conduct the review. Provide operational support without directing or compromising an independent reviewer's findings.
- Establish a clear plan for each Director-led case, including responsible parties, next steps, deadlines, and follow-up. Escalate decisions or resource barriers beyond the Director's authority to the Executive Director and confirm completion of resolution commitments.
Case Management alignment and timely resolution- Meet routinely with Case Management leadership, with the department managers participating as appropriate, to maintain alignment on appeal and grievance workflows, pending cases, responsibilities, decision authority, training needs, and emerging concerns.
- Ensure timely resolution in partnership with Case Management by establishing expectations for information sharing, records, decisions, and completion of assigned actions. Hold the department's managers accountable for coordination and follow-through and address delays with the responsible case management leader. The director will work collaboratively and in partnership with directors across other departments to coordinate follow through, address delays, and strengthen communication and accountability in resolving case management matters, ensure alignment on priorities, and timely effective outcomes.
- Use routine meetings to review cases approaching deadlines, stalled resolutions, recurring issues, and implementation barriers. Document agreed actions, owners, and timelines; verify progress and escalate unresolved delays.
- Establish additional case conferences when needed for complex or urgent matters. Maintain clear communication between departments while preserving fair review, applicable appeal rights, and grievance reviewer independence.
Proactive training and consultation- Set the department's training priorities with Case Management leadership based on case trends, quality reviews, and emerging requirements. Delegate development and delivery of routine onboarding, refresher training, and case consultation to managers and qualified staff.
- Coach managers in effective training and consultation. Personally lead training on complex, sensitive, or organization-wide issues when needed, including person-centered planning, communication, documentation, rights, and early problem resolution.
- Oversee evaluation of training effectiveness and work with Case Management leaders to assess changes in practice, responsiveness, follow-through, and recurrence of preventable concerns.
Data analysis and organizational improvement- Establish data definitions, dashboard requirements, and reporting expectations. Delegate routine data collection, case coding, data validation, and report preparation to managers and designated staff.
- Review and interpret separate appeals and grievance dashboards, including volumes and rates, themes, case aging, deadline adherence, outcomes, action completion, repeat concerns, state-level review results, and participant feedback. Assess patterns across offices, programs, and language groups with appropriate privacy protections.
- Identify underlying operational and policy issues, validate findings with Case Management and other departments, and develop practical proposals for ELT. Include the evidence, recommended change, accountable owner, resource needs, timeline, and expected outcome.
- Coordinate approved improvements with responsible leaders, oversee implementation, and assess results. Report progress, barriers, and recommended adjustments to ELT.
- Hold managers accountable for accurate and timely DDS submissions and audit support. Evaluate department performance through timeliness, resolution quality, accessibility, follow-through, and reduced recurrence; do not rely solely on lower complaint volume or agency hearing outcomes.
Partnership and professional responsibilities- Serve as a leadership liaison to DDS, legal counsel, advocacy organizations, service providers, and other partners. Delegate routine liaison activities to managers and provide presentations to leadership and board committees as assigned.
- Maintain strategic awareness of evolving state-level legislation, regulation, DDS directives, and agency policies to proactively assess their operational impact, guide management in implementing necessary procedural updates, and ensure timely communication and staff training in response to emerging changes
- Promote respectful communication, confidentiality, impartial review, and protection from retaliation. Perform other related duties consistent with the position.
Employment Standards To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.
Education & ExperienceA master's degree in social work, public administration, public policy, human services, dispute resolution, or a related field, or a Juris Doctor degree; and at least seven years of progressively responsible experience in developmental services, human services, appeals, grievance resolution, compliance, or a closely related field, including at least three years managing staff or programs. An equivalent combination of education and directly relevant experience may be considered.
At least 3 years of demonstrated experience developing and overseeing supervisors or managers, delegating operations, leading challenging cases, coordinating timely resolution across departments, delivering staff training, analyzing performance data, and implementing improvements is required. Experience supervising managers and knowledge of California regional center operations, administrative hearings, and person-centered grievance resolution are strongly preferred. A Juris Doctor degree does not substitute for management experience.
Skills and Abilities - Promote respectful communication, confidentiality, impartial review, and protection from retaliation. Perform other related duties consistent with the position.
- Working knowledge of the Lanterman Act, service and eligibility appeals, applicable grievance requirements, Early Start processes, relevant Title 17 and Title 22 provisions, and HCBS person-centered planning and settings requirements.
- Ability to interpret complex requirements and translate them into clear procedures, training, and reliable operations.
- Strong management, coaching, conflict resolution, interviewing, analytical, and written communication skills; ability to exercise independent judgment and identify conflicts of interest.
- Ability to build and interpret dashboards, explain trends and limitations, develop practical proposals, and assess whether changes improve outcomes.
- Ability to build cross-department cooperation, establish shared timelines and accountability, engage respectfully with individuals and families, and lead challenging cases with impartiality and appropriate urgency.
Essential Requirements Ability to perform essential duties with or without reasonable accommodation; attend meetings and provide training across NLACRC's service area; and maintain reliable transportation or an acceptable alternative. Maintain confidentiality and comply with applicable information security and records requirements.
NLACRC Offers an Excellent Benefits Package We offer employees a variety of health and dental plans:
- Health Insurance - We provide a generous contribution to additional plans that the employee may select for employee only or employee and dependents costs.
- Dental Insurance - NLACRC pays the full cost of the Dental DMO Plan for employees and eligible dependents. We also offer a Dental PPO plan with a low employee monthly contribution for employees and eligible dependents
- Pre-Tax Flexible Spending Account for eligible health care expenses
- Pre-Tax Dependent Care Flexible Spending Account for eligible dependent care expenses
- No cost Life, Accidental Death & Disability, Long Term Disability Insurance for employees
- No cost Vision plan for employees and eligible dependents
- Retirement plan - NLACRC is a member of CalPERS which is a defined
