Clinical Nurse Reviewer – STAR Kids Audit Oversight

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🔥 2 minutes ago

🤠 Texas – Remote

🤠 Texas – Remote

💵 $60.5k - $129.6k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

👻 Ghost score 0%

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CVS Health

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10,000+ employees

Founded 1963

🏥 Healthcare

⚕️ Healthcare Insurance

🛒 Retail

Healthcare • Healthcare Insurance • Retail

CVS Health is a leading American healthcare company dedicated to improving health access and affordability. The company focuses on a comprehensive approach that includes health services, health insurance, and pharmacy benefits management. Through its subsidiaries, such as Aetna and CVS Caremark, CVS Health offers a range of services that facilitate wellness, condition management, and affordable prescription drug coverage. CVS Health operates neighborhood pharmacies, provides mail-order pharmacy services, and manages specialty medication programs, aiming to make healthcare convenient and accessible for everyone. Driven by a mission to connect people with essential care services, CVS Health is committed to fostering healthier communities and supporting the wellbeing of all individuals.

📋 Description

• Lead the coordination and execution of monthly rolling STAR Kids state audit submissions • Pull, merge, and organize required documentation from multiple sources • Prepare documents through formatting and bookmarking according to state standards • Track submission timelines and maintain audit documentation logs • Serve as the subject matter expert for STAR Kids audit processes • Conduct comprehensive monthly reviews of STAR Kids service coordination charts • Identify documentation gaps, compliance risks, and trends • Provide written risk analysis reports and targeted quality-improvement recommendations • Collaborate with service coordination supervisors and quality teams on corrective actions and process improvements • Maintain month-over-month audit readiness through proactive risk-reduction strategies

🎯 Requirements

• Active and Unrestricted Texas or Compact RN Licensure • 2 Years STAR Kids MDCP Experience • Must reside in Texas • Associate Degree in Nursing • Preferred: Previous auditing experience

🏖️ Benefits

• Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being • CVS Health bonus, commission or short-term incentive program in addition to base pay

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