Clinical Review Specialist - Baylor Weekend

Pinnacle Home Care, the largest independent home health 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 range 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 every day. We strive to help our patients confidently manage their health at home and maintain their dignity, not only now, 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.

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.

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/KanTime 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 (KanTime experience preferred; WellSky training provided). 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.