Clinical Nurse Reviewer

We're building a world of health around every individual , shaping a more connected, convenient, and compassionate health experience. At CVS Health, you'll be surrounded by colleagues who care deeply, innovate with purpose, and prioritize safety and quality in everything they do.

The Clinical Nurse Reviewer will serve as the designated lead for STAR Kids rolling month state audit submissions. This role is responsible for the full oversight, coordination, and execution of the audit process. The nurse will work collaboratively with service coordination teams, quality assurance, and leadership to ensure timely, accurate, and audit-ready documentation.

Key Responsibilities:

• Audit Submission Oversight & Management:
• Lead the coordination and execution of monthly rolling STAR Kids state audit submissions.
• Pull, merge, and organize all required documentation from multiple sources to meet state audit requirements.
• Perform document preparation, including formatting and bookmarking in compliance with state standards.
• Track submission timelines, ensure deadlines are met, and maintain audit documentation logs.
• Serve as the subject matter expert for STAR Kids audit processes, providing guidance and updates to internal teams.

• Quality Assurance & Documentation Review:
• Conduct comprehensive monthly reviews of STAR Kids service coordination charts to ensure documentation compliance and audit readiness.
• Identify documentation gaps, compliance risks, and trends across service coordination records.
• Provide written risk analysis reports and develop targeted recommendations for quality improvement.
• Collaborate with service coordination supervisors and quality teams to implement corrective actions and process improvements.

• Continuous Improvement & Readiness:
• Maintain audit readiness month-over-month by developing proactive strategies to reduce risk.

Required Qualifications:

• Active and Unrestricted Texas or Compact RN Licensure
• 2 Years STAR Kids MDCP Experience
• Must reside in Texas

Preferred Qualifications:

• Previous auditing experience

Education:

• Associate Degree in Nursing

Anticipated Weekly Hours: 40

Time Type: Full-time

Pay Range: $60,522.00 - $129,615.00

This position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well-being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.