Fair Hearing & Appeals Specialist

U POSITION OVERVIEW

This position is responsible for representing CVRC management at eligibility and purchase of services appeals six-county wide; consulting and training with staff and management on the appeal process in such areas as measures to prevent appeals, negotiating settlements, and preparation and attendance at informal meetings, administrative hearings and mediations; and may handle vendor appeals, complaints filed under W&I 4731 and individuals rights violations as specified in Title 17 50540.

U ESSENTIAL FUNCTIONS

• Develops and updates policies, procedures, and templates related to appeals, Notices of Action, fair hearings, and complaint resolution.
• Review, advise, and ensure compliance with the regulations and statutes including all 4731 complaints as designated by the Executive Director.
• Monitors and tracks appeals, informals, mediations, fair hearings and 4731 complaints.
• Represents CVRC at mediation sessions and fair hearings and negotiates settlements of appeals.
• From receipt of submission to resolution, schedules and conducts informal meetings, mediations and fair hearings with appellants
• Coordinates mediation and fair hearing activities through the Office of Administrative Hearings (OAH); prepares staff to serve as witnesses in fair hearings.
• Monitors case progress, procedural requirements, and regulatory timelines to ensure timely completion of all hearing-related actions, documentation, and appeal processes.
• Treats appellants with professionalism and respect and informs them of their rights and responsibilities.
• Investigates 4731 complaints by gathering and analyzing relevant information, conducting fact-finding activities, preparing written responses and reports, and collaborating with appropriate departments as necessary to ensure appropriate resolution.
• Provides consultation and education to staff and vendors on the requirements of the Lanterman Act, Title 17, and CVRC purchase of services guidelines in relation to Notice of Actions and appeals process.
• Maintain current knowledge and understanding of the purpose and procedures for public transparency regulation and policies.
• Exercises sound judgment and maintains strict confidentiality when handling sensitive consumer, personnel, and legal information.
• Maintains working knowledge of community resources and services relevant to appeals and fair hearing processes to support informed decision-making, issue resolution, and effective customer service.
• Participates in department and cross-functional initiatives as assigned or needed to support organizational goals, strategic priorities, and mission-driven outcomes.
• Works collaboratively with colleagues across the agency to support service delivery, appeals processes, and continuity of operations while maintaining accountability for assigned responsibilities.
• Supports effective and efficient business practice.
• Maintains positive business relationships, confidentiality, good attendance, punctuality, and acts in accordance with all company policies and procedures.
• This job description reflects management’s assignment of essential functions; it does not prescribe or restrict the tasks that may be assigned.

MINIMUM QUALIFICATIONS

• Bachelor's degree or higher in social work, psychology, nursing, rehabilitation, or a related human services field, and a minimum of five (5) years of experience in the developmental disabilities field, including at least three (3) years of experience with CVRC.
• Demonstrated skills in conflict resolution.
• Ability to relate to others comfortably and be able to establish and maintain effective relationships.
• Ability to prioritize varied work assignments and complete documentation within required timelines.
• Ability to deal with a wide variety of situations and complex issues and the ability to negotiate successfully or prepare effective presentations for administrative law judges.
• Extensive knowledge of the Lanterman Act, Title 17, and CVRC purchase of services guidelines.
• Ability to use a personal computer and software in order to access information systems, email and perform other required computerized functions.
• Must demonstrate initiative, self-motivation, sound independent judgment, flexibility, strong interpersonal, and excellent written and oral communication skills.

PREFERRED QUALIFICATIONS

• Experience in participation in administrative appeals is highly desirable.
• Knowledge of generic public resources and developmental disabilities is desirable.
• Bilingual skills are desirable.

U TRAVEL REQUIREMENTS

• Must have the ability to travel within CVRC’s six-county-wide region as assigned or required.

U WORKING CONDITIONS

Professional office environment. Noise level in the office is low to moderate depending on area. Individual workspace assigned and varies from open cubicle to private office.

U PHYSICAL REQUIREMENTS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions . Manual dexterity for typing on a computer keyboard. Specific vision abilities including close vision, distance vision, depth perception, and ability to adjust focus required to view computer monitor, read numbers and printed material. Mobility sufficient to reach, lift and transport files and other work material to work areas. Sitting for extended periods of time. Mobility sufficient to travel to appointments and public meetings. Ability to dictate reports. Availability and capability to respond to individuals’ special needs, incidents, and crisis intervention.