Clinical Review Specialist -LPN

Pinnacle Career • Oldsmar, FL

1d

About The Position

Pinnacle Home Care Holdings, LLC ("Pinnacle") is a leading Florida-based provider of home healthcare services, dedicated to delivering compassionate healthcare at home. The company is seeking an experienced Clinical Review Specialist to join its growing team. This role is crucial for ensuring that every patient's care plan begins with clinical excellence, regulatory compliance, and a compassionate approach.

Requirements

• 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 and Microsoft Office Suite (Outlook, Teams, Excel).
• Ability to work in a fast-paced, high-volume environment with accuracy and composure.

Nice To Haves

• KanTime experience
• WellSky/KanTime preferred

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/KanTime 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 (KanTime experience preferred; 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.

Benefits

• 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.
• Supportive & Fun Culture: Join a collaborative, forward-thinking team that values both professional excellence and personal fulfillment.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Associate degree
• Number of Employees: 1-10 employees