Clinical Review Specialist - LPN

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.

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.

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.