Clinical Review Specialist

Are you looking to make a difference in patients’ lives with a company that values your expertise? Join us in our mission of delivering compassionate healthcare where it matters most –– at home. Pinnacle Home Care Holdings, LLC ("Pinnacle") is a leading Florida-based provider of home healthcare services. We're seeking an experienced Clinical Review Specialist to join our growing team and ensure every patient's care plan starts with clinical excellence, regulatory compliance, and a compassionate touch. Key Responsibilities Review all incoming home health orders for clinical appropriateness. Determine appropriate disciplines, frequencies, and visit types in line with agency protocols and referral source requirements. Confirm compliance with CMS guidelines, Medicare Conditions of Participation (COPs), and internal agency standards. Take and document verbal orders from physicians and referral sources accurately and efficiently. Perform patient welcome calls to ensure a smooth, positive onboarding experience. Triage and troubleshoot patient needs or concerns during intake conversations. Maintain a warm, empathetic, and professional phone presence to reassure patients and referral partners. Accurately document all intake and order-related activities in the EMR (WellSky or similar). Ensure physician orders, care plans, and required documentation are completed, accurate, and properly uploaded. Maintain an up-to-date understanding of home health regulatory requirements, including Medicare, CMS, and state guidelines. Proficient in EMR data entry (WellSky training provided). Comfortable using Microsoft Outlook, Teams, and internal reporting tools. Follow daily reporting and tracking requirements to support transparency. Partner closely with Intake, Care Coordination, and Branch leadership to ensure timely patient starts of care. Escalate clinical concerns or regulatory issues promptly to the Clinical Review Manager. Support branch and central teams with troubleshooting and guidance on referral-related issues. Qualifications Current LPN with equivalent experience in home health intake/clinical review. 2+ years of clinical experience in home health, intake, or care coordination. Knowledge of Medicare COPs, CMS guidelines, and general home health regulations. Strong critical thinking and clinical decision-making skills. Excellent communication and phone skills; ability to build trust with patients, referral sources, and colleagues. Proficiency with EMR systems (WellSky preferred) and Microsoft Office Suite (Outlook, Teams, Excel). Ability to work in a fast-paced, high-volume environment with accuracy and composure. Benefits Why Choose Pinnacle? Personalized, One-on-One Care: Help patients heal and regain their independence by delivering individualized care in the comfort of their homes. Growth & Stability: Over two decades as Florida’s largest independent home health agency. Ongoing Professional Development: Free Continuing Education Units (CEUs) to support licensure and career advancement. Competitive Benefits & Perks: Including an employee referral program where you can earn rewards. Recognized Excellence: Ranked as a USA Today Top Workplace. Flexible Scheduling: Enjoy a schedule that aligns with your personal priorities. Supportive & Fun Culture: Join a collaborative, forward-thinking team that values both professional excellence and personal fulfillment. Pinnacle promotes an inclusive environment and is an equal opportunity employer. We prohibit discrimination or harassment based on race, religion, age, gender, national origin, disability, veteran status, or other legally protected characteristics. Be part of a company that empowers clinicians to make a difference in the lives of over 10,000 patients across Florida every day. #J-18808-Ljbffr