Clinical Reviewer Jobs

About The Position

Requirements

• Active and unrestricted Texas or Compact RN licensure.
• Two years of STAR Kids MDCP experience.
• Must reside in Texas.
• Associate Degree in Nursing.

Nice To Haves

• Previous auditing experience.

Responsibilities

• Lead coordination and execution of monthly rolling STAR Kids state audit submissions.
• Pull, merge, and organize documentation from multiple sources to meet state audit requirements.
• Prepare documents, 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 and provide guidance and updates to internal teams.
• Conduct comprehensive monthly reviews of STAR Kids service coordination charts for documentation compliance and audit readiness.
• Identify documentation gaps, compliance risks, and trends across service coordination records.
• Provide written risk analysis reports and develop targeted quality improvement recommendations.
• Collaborate with service coordination supervisors and quality teams to implement corrective actions and process improvements.
• Develop proactive strategies to reduce risk and maintain month-to-month audit readiness.

Benefits

• Medical coverage.
• Dental coverage.
• Vision coverage.
• Paid time off.
• Retirement savings options.
• Wellness programs.
• Other resources, based on eligibility.
• Eligibility for a CVS Health bonus, commission, or short-term incentive program.