At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care.As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues - caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.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:
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• 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 riskRequired Qualifications
- 2 Years STAR Kids MDCP Experience
- Associate Degree in Nursing
40Time Type
Full timePay Range
The typical pay range for this role is:$60,522.00 - $129,615.00This 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 peopleWe take pride in our comprehensive and competitive mix of pay and benefits - investing in the physical, emotional and financial wellness of our colleagues and their families to help them be the healthiest they can be. In addition to our competitive wages, our great benefits include:
- Affordable medical plan options, a 401(k) plan (including matching company contributions), and an employee stock purchase plan.
- No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
- Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility.