RN Clinical Review Team Manager

Job Description

Job Description

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, Florida’s largest Medicare-certified home health provider, has been delivering high-quality, patient-centered care for over two decades, and we’re looking for a Registered Nurse Clinical Review Manager to join our award-winning team.

Key Responsibilities

• Oversee clinical review of referrals to ensure medical necessity, regulatory compliance, and quality care delivery.
• Lead and mentor a team of Clinical Review Specialists, promoting accuracy, accountability, and professional growth.
• Partner with operations, physicians, and revenue cycle teams to resolve complex cases and streamline processes.
• Ensure documentation, care plans, and visit utilization align with payer guidelines and agency standards.
• Monitor performance metrics, conduct audits, and drive continuous improvement in quality and efficiency.
• Maintain compliance with CMS, state, and accrediting regulations while fostering a culture of excellence and collaboration.

Qualifications

Why Choose Pinnacle?

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!