Due Diligence Clinical Review Specialist

Pennant Services • Eagle, ID

23d • Remote

About The Position

We are building a world-class service Center and invite you to join a team of people who are committed to a core objective of supporting life-changing service and providing professional expertise to the operations and leaders we support. About the Company Pennant Services is one of the most dynamic and progressive companies in the rapidly expanding senior living, home health, hospice, and home care industries. Affiliates of Pennant Services now operate over 150 senior living, home health, hospice, and home care operations across 14 states, and we are growing! These operations have no corporate headquarters or traditional management hierarchy. Instead, they operate independently with support from the “Service Center,” a world-class service team that provides the centralized clinical, legal, compliance, risk management, HR, training, accounting, IT and other resources necessary to allow on-site leaders and caregivers to focus squarely on day-to-day care and business issues in their individual agencies. Something else that sets us apart from other companies is the quality of our most valuable resources – our people! We are dedicated to living out our culture as defined by our core values, “ CAPLICO ”: C ustomer Second A ccountability P assion for Learning L ove One Another I ntelligent Risk Taking C elebrate O wnership By incorporating these principles at all levels of our organization, our employees feel valued and excited about their impact on our service center team members and operational partners. Our culture fosters personal and professional excellence and promotes development that leads to continued success. JOB SUMMARY The Due Diligence Clinical Review Specialist plays a critical role in evaluating clinical, regulatory, and operational compliance risks during home health and hospice acquisitions. This position is responsible for conducting comprehensive clinical documentation and compliance reviews with a strong focus on CMS Conditions of Participation and Conditions of Payment. The ideal candidate is a self-motivated clinician with multi-EMR expertise (including HCHB), the ability to comprehend and apply data analytics , and the skills to assess clinical risk, identify compliance gaps, and provide actionable recommendations to leadership.

Requirements

• Minimum 5 years of experience in Home Health and/or Hospice, with strong knowledge of CMS Conditions of Payment and Conditions of Participation.
• Proficiency in multiple EMRs, including required experience with HCHB.
• Strong ability to interpret and apply data analytics, prepare trending reports, and identify compliance and financial risks.
• Demonstrated ability to work independently, exercise sound judgment, and meet deadlines in a fast-paced environment.
• Strong written and verbal communication skills, with the ability to present findings to executive leadership.
• High attention to detail and ability to identify patterns, trends, and systemic risks.
• Proficient in Microsoft Office Suite (Excel, Word, PowerPoint, Smartsheet).
• Flexibility to cross-train in audit review processes and support audit defense activities as part of the broader Denials Management team.
• Able to adapt to a fast-paced environment and learn and retain new or evolving information and procedures.

Nice To Haves

• Prior experience with due diligence, compliance, or audit review processes highly preferred.

Responsibilities

• Ensures CAPLICO Core Values and Code of Conduct are always adhered to .
• Perform due diligence clinical reviews for home health and hospice acquisitions, ensuring compliance with federal, state, and payer regulations.
• Understands and applies COP’s (Medicare guidelines), and all other appropriate CMS or payer program guidelines as it relates to home health care and hospice.
• Identify risks that may affect reimbursement, compliance, and clinical outcomes.
• Review and analyze records across multiple EMRs, including Homecare Homebase (HCHB) and other common systems.
• Comprehend and implement data analytics to generate trending reports, identify systemic risks, and inform leadership decisions.
• Create, update, and maintain data analytics platforms to monitor review outcomes and agency risk profiles.
• Provide written and verbal reports summarizing findings, including clinical, regulatory, and financial risk insights.
• Collaborate with leadership, denials management, and agency partners to recommend corrective actions and process improvements.
• Develop and deliver education and training to agencies on documentation best practices, defensible documentation, and regulatory requirements.
• Track and trend common deficiencies identified during reviews; escalating systemic issues to leadership.
• Participate in cross-training for audit review processes (e.g., RAC, TPE, SMRC, UPIC, Medicare Advantage), supporting the Denials Management team as needed.
• Maintain up-to-date knowledge of CMS regulations, industry best practices, and payer requirements.
• Contribute to continuous improvement initiatives in due diligence and compliance review processes.
• Must be able to effectively manage multiple assignments, create documentation outlining findings and/or documenting suggestions, organize and prioritize workload .
• Highly flexible and motivated with an ability to work independently as well as in a team setting.

Benefits

• We offer a comprehensive benefits package, from a choice of medical, dental, and vision plans to retirement savings opportunities through a 401(k), company match, and various other features.
• We believe in great work and celebrate our employees' efforts and accomplishments locally and companywide, recognizing people daily through our Moments of Truth Program.
• In addition to recognition,n we believe in supporting our employees' professional growth and development. We provide employees with a wide range of free e-courses through our Learning Management System, as well as training sessions and seminars.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed