Clinical Review Specialist PRN

Pinnacle Home Care•Oldsmar, FL

6d•Onsite

About The Position

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. This role involves reviewing incoming home health orders for clinical appropriateness, determining appropriate disciplines, frequencies, and visit types, and ensuring compliance with CMS guidelines, Medicare Conditions of Participation (COPs), and internal agency standards. The specialist will also take and document verbal orders, perform patient welcome calls, triage patient needs, and maintain accurate documentation in the EMR.

Requirements

Current LPN or RN 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.

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 preferred).
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.