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Clinical Review Specialist
Pinnacle Home CareClinical Review Specialist responsible for reviewing home health orders and ensuring compliance with regulations. Join Pinnacle Home Care to deliver compassionate healthcare at home.
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in home health intake processes, ensuring compliance with Medicare and CMS guidelines while maintaining a professional and empathetic communication style. Proficient in EMR data entry and capable of effectively triaging patient needs in a fast-paced environment.
Highest-signal resume keywords
Current LPN2+ Years Clinical Experience in Home HealthKnowledge of Medicare COPsProficiency with EMR SystemsExcellent Communication Skills
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Clinical ReviewPatient OnboardingTriage and TroubleshootingDocumentation AccuracyCritical ThinkingClinical Decision-Making
Soft Skills
Empathetic CommunicationTrust BuildingProfessional Phone Presence
Tools & Technologies
WellSky EMRMicrosoft OutlookMicrosoft TeamsMicrosoft Excel
Certifications & Qualifications
Licensed Practical Nurse (LPN)
Industry Keywords
Home Health RegulationsCMS GuidelinesMedicare Conditions of ParticipationIntake CoordinationCare Coordination
About the role
Key responsibilities & impact- 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 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.
Requirements
What you’ll need- Current LPN 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.
Benefits
Comp & perks- 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.