Clinical Nurse Reviewer – STAR Kids Audit Oversight
About The Position
The Clinical Nurse Reviewer serves as the designated lead for STAR Kids rolling-month state audit submissions and is responsible for overseeing, coordinating, and executing the audit process. The role works collaboratively with service coordination teams, quality assurance, and leadership to ensure documentation is accurate, timely, and audit-ready. It requires clinical knowledge, critical thinking, and strong organizational skills to maintain ongoing audit readiness and support continuous quality improvement. The position leads monthly audit submissions, gathers and prepares documentation to meet state requirements, monitors deadlines and audit records, and provides guidance as a subject matter expert. It also reviews STAR Kids service coordination charts, identifies documentation gaps and compliance risks, produces written risk analyses and recommendations, and collaborates with relevant teams on corrective actions and process improvements.
Requirements
- Active and unrestricted Texas or Compact RN licensure.
- Two years of STAR Kids MDCP experience.
- Must reside in Texas.
Nice To Haves
- Previous auditing experience.
Responsibilities
- Lead the coordination and execution of monthly rolling STAR Kids state audit submissions.
- Pull, merge, and organize required documentation from multiple sources to meet state audit requirements.
- Format and bookmark documents 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 and provide guidance and updates to internal teams.
- 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.
- Maintain month-over-month audit readiness by developing proactive strategies to reduce risk.
Benefits
- Medical coverage
- Dental coverage
- Vision coverage
- Paid time off
- Retirement savings options
- Wellness programs
- Other resources, based on eligibility
- Eligible for a CVS Health bonus, commission, or short-term incentive program
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
