Pinnacle Home Care Inc.
Home Health Clinical Review Specialist
Orlando, Florida•Full-time
About the Job
Are you looking to make a difference in patients’ lives with a company that values your expertise? Join us in our mission of delivering compassionate healthcare where it matters most –– at home.
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, regulatory compliance, and a compassionate touch.
Qualifications:
Qualifications:
- Current LPN with equivalent experience in home health intake/clinical review.
- 2+ years of skilled home health experience in home health, intake, or care coordination, preferable with a Medicare-certified home health agency.
- Experience reviewing physician orders, referrals, authorizations, care plans, OASIS documentation, or other home health clinical documentation.
- 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.
Key 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.
Why Choose Pinnacle?
- Personalized, One-on-One Care: Help patients heal and regain their independence by delivering individualized care in the comfort of their homes.
- 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.
- Flexible Scheduling: Enjoy a schedule that aligns with your personal priorities.
- Supportive & Fun Culture: Join a collaborative, forward-thinking team that values both professional excellence and personal fulfillment.
Pinnacle promotes an inclusive environment and is an equal opportunity employer. We prohibit discrimination or harassment based on race, religion, age, gender, national origin, disability, veteran status, or other legally protected characteristics.
Be part of a company that empowers clinicians to make a difference in the lives of over 10,000 patients across Florida every day. Apply now!
About Pinnacle Home Care Inc.
Pinnacle has 16 locations throughout Florida hiring for Healthcare Sales Professionals, Clinical Managers, RNs, LPNs, PTs, PTAs, SLPs, OTs, OTAs and other Healthcare positions. If you don't see a role that meets your skill set on the job board, send us your resume directly to leadgeneration@pinnnaclehomecare.net
Please include your full name and location! We look forward to assisting you in exploring career opportunities with Pinnacle Home Care!
About Us:
Pinnacle Home Care, the largest independent home healthcare provider in Florida, has proudly served our communities for over two decades.
We are a team driven by a passion for home healthcare with an unwavering commitment to the well-being of our patients and their families. At Pinnacle, we foster a forward-thinking, collaborative workplace culture. This has earned us multiple recognitions including the Top Workplaces USA award – a testament to our focus on supporting and empowering our employees.
We offer a comprehensive suite of services, including skilled nursing, physical therapy, occupational therapy, speech therapy, medical social work and home health aide support to more than 10,000 patients across our service areas. We strive to help seniors thrive, not only under our care, but long after our services are complete.
At Pinnacle, we are proud to make a meaningful difference in the lives of patients and their families every day. Join us in our mission to deliver compassionate healthcare where it matters most – at home.
Please include your full name and location! We look forward to assisting you in exploring career opportunities with Pinnacle Home Care!
About Us:
Pinnacle Home Care, the largest independent home healthcare provider in Florida, has proudly served our communities for over two decades.
We are a team driven by a passion for home healthcare with an unwavering commitment to the well-being of our patients and their families. At Pinnacle, we foster a forward-thinking, collaborative workplace culture. This has earned us multiple recognitions including the Top Workplaces USA award – a testament to our focus on supporting and empowering our employees.
We offer a comprehensive suite of services, including skilled nursing, physical therapy, occupational therapy, speech therapy, medical social work and home health aide support to more than 10,000 patients across our service areas. We strive to help seniors thrive, not only under our care, but long after our services are complete.
At Pinnacle, we are proud to make a meaningful difference in the lives of patients and their families every day. Join us in our mission to deliver compassionate healthcare where it matters most – at home.