Clinical Nurse Reviewer – STAR Kids Audit Oversight

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 passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Summary 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. The position requires critical thinking, clinical knowledge, and excellent organizational skills to maintain ongoing audit readiness and support continuous quality improvement. 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 The typical pay range for this role is: $60,522.00 - $129,615.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls.  The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.  This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.    Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full‑time 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. Additional de