RN Clinical Review Team Manager

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 Floridas largest Medicare-certified home health provider has been delivering high-quality patient-centered care for over two decades and were 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

• Active unrestricted RN PT or equivalent clinical license required (multi-state preferred).
• Minimum 3-5 years of recent experience in home health utilization review or compliance auditing.
• Minimum 2 years of supervisory or leadership experience in a healthcare setting.
• Strong knowledge of home health regulations payer requirements and reimbursement methodologies.
• Proven ability to manage team productivity accuracy and performance outcomes.
• Strong financial acumen with experience in balancing clinical care planning and cost control.
• Excellent leadership communication and conflict resolution skills.
• Highly organized detail-oriented and skilled at prioritizing in a challenging environment.
• Proficiency with EMR systems workflow management and performance tracking tools.

Why Choose Pinnacle

• Growth & Stability: Over two decades as Floridas largest home health agency.
• Ongoing Professional Development: Free Continuing Education Units (CEUs) to support licensure and career advancement.
• Competitive Benefits & Perks: Including Daily Pay (work today get paid tomorrow!) and an employee referral program where you can earn rewards.
• Recognized Excellence: Ranked as a USA Today Top Workplace.
• 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 10000 patients across Florida every day.Apply now!

Required Experience:

Manager