PRN Clinical Review - Weekends

Pinnacle Home Care • Oldsmar, FL

8d • Remote

About The Position

Pinnacle Home Care Holdings, LLC ("Pinnacle") is seeking an experienced Clinical Review Specialist to join their growing team. This role is crucial in ensuring every patient's care plan starts with clinical excellence. The position involves reviewing incoming home health orders for clinical appropriateness, determining appropriate disciplines, frequencies, and visit types, and confirming compliance with various healthcare regulations. The specialist will also take and document verbal orders, perform patient welcome calls, triage patient needs, and maintain accurate documentation in the EMR. A key aspect of the role is maintaining an up-to-date understanding of home health regulatory requirements and collaborating with internal teams to ensure timely patient starts of care.

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.

Nice To Haves

• Proficient in EMR data entry (WellSky preferred)
• Comfortable using Microsoft Outlook, Teams, and internal reporting tools.

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.
• 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

• Personalized, One-on-One Care
• Growth & Stability
• 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
• Supportive & Fun Culture

What This Job Offers

• Career Level: Mid Level
• Education Level: Associate degree