Clinical Review Specialist

About the Role

Join Pinnacle Home Care, a leading Florida-based provider of home healthcare services, in a vital role dedicated to ensuring clinical excellence and compassionate care for patients receiving care at home. As a Clinical Review Specialist, you will be instrumental in validating patient care plans with strict adherence to regulatory standards while delivering a supportive patient onboarding experience.

Responsibilities

• Evaluate all incoming home health orders for clinical accuracy and appropriateness.
• Decide on suitable healthcare disciplines, frequency, and types of visits compliant with agency and referral source protocols.
• Verify adherence to CMS guidelines, Medicare Conditions of Participation, and internal policies.
• Accurately record verbal physician and referral source orders.
• Conduct welcoming calls to patients to facilitate smooth initiation of care services.
• Address patient queries and requirements during intake promptly and empathetically.
• Maintain a professional and comforting telephone demeanor to reassure patients and referral partners.
• Document all order and intake activity precisely within the electronic medical records system (WellSky or equivalent).
• Ensure correctness and completeness of physician orders, care plans, and documentation uploads.
• Stay informed on up-to-date home health regulatory policies including Medicare, CMS, and relevant state regulations.
• Demonstrate proficiency in EMR data entry and utilize Microsoft Office tools, including Outlook and Teams.
• Follow daily reporting protocols to maintain operational transparency.
• Collaborate closely with Intake, Care Coordination, and Branch Leadership for efficient patient care commencement.
• Promptly report clinical or regulatory concerns to the Clinical Review Manager.
• Assist branch and centralized teams in resolving referral-related challenges.

Qualifications

• Active Licensed Practical Nurse (LPN) with home health intake or clinical review experience.
• Minimum of two years’ clinical experience in home health, intake, or care coordination roles.
• In-depth knowledge of Medicare Conditions of Participation, CMS guidelines, and home health regulations.
• Strong analytical and clinical decision-making capabilities.
• Excellent communication skills with the ability to foster trust among patients, referral sources, and team members.
• Competence in using EMR platforms, preferably WellSky, and Microsoft Office applications such as Outlook, Teams, and Excel.
• Capacity to perform efficiently in a dynamic, high-volume work environment while maintaining accuracy and composure.

Benefits and Company Culture

• Deliver personalized care that promotes healing and independence within patients' homes.
• Join Florida’s largest independent home health agency with more than twenty years of industry presence.
• Access free continuing education units (CEUs) for professional development and licensure maintenance.
• Enjoy competitive benefits, a rewarding employee referral program, and flexible scheduling options.
• Be part of an award-winning workplace recognized by USA Today.
• Work within a supportive, fun, and collaborative team environment focused on professional and personal growth.

Equal Opportunity Statement

Pinnacle fosters an inclusive workplace culture, actively prohibiting discrimination or harassment based on any protected characteristic such as race, religion, age, gender, disability, or veteran status.

Join Us

Contribute your expertise to enhance the lives of over 10,000 patients across Florida each day by becoming part of Pinnacle’s dedicated clinical team.