Clinical Review Specialist

🕒 August 13

🐊 Florida – Remote

🐊 Florida – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

🔍🏥 Medical Reviewer

👻 Ghost score 24%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Pinnacle Home Care

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 2003

🏥 Healthcare

👥 B2C

Healthcare • B2C

Pinnacle Home Care is a Florida-based home healthcare provider that delivers a broad range of in-home clinical services. Since 2003 the company has grown into the largest independent home health provider in Florida, serving over 310,000 patients to date and caring for more than 10,000 patients daily. Pinnacle provides skilled nursing, physical/occupational/speech therapy, medical social work, behavioral health, remote patient monitoring (through a RemoteFocus partnership), and specialty post-acute services including cardiac, pulmonary, neurological, diabetic, surgical, urological, and wound care — all focused on preventing readmissions and supporting patients’ independence at home.

📋 Description

• 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 • Document 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 • Use Microsoft Outlook, Teams, and internal reporting tools • Follow daily reporting and tracking requirements • Partner with Intake, Care Coordination, and Branch leadership to ensure timely patient starts of care • Escalate clinical concerns or regulatory issues to the Clinical Review Manager • Support branch and central teams with troubleshooting and guidance on referral-related issues

🎯 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 • Ability to work two weekends per month, Saturday and Sunday, 8:00AM - 6:30 PM Eastern Time Zone

🏖️ Benefits

• Free Continuing Education Units (CEUs) to support licensure and career advancement • Employee referral program where you can earn rewards • Flexible Scheduling • Supportive & Fun Culture • Inclusive environment and equal opportunity employment