Medical Review Officer (MRO) - Bid MaximusMedical Review Officer (MRO) - BidCheyenne, WYFull timeMaximus compensation is based on various factors including but not limited to job location, a candidate's education, training, experience, expected quality and quantity of work, required travel (if any), external market and internal value analysis including seniority and merit systems, as well as internal pay alignment. - After completing all research, the physician must write a case rationale in the correct format that introduces the question at hand, summarizes the correct guideline, analyses the pertinent case details related to the guideline, and then make a final determination as to the medical necessity of the requested service.
Clinical Quality Review Team Lead TriWest Healthcare AllianceClinical Quality Review Team LeadCheyenne, WYRemoteFull timeThe team lead supports clinical and non-clinical staff supporting CQM programs by providing training and onboarding of new staff; determining work assignments; performing audits for clinical records and/or work accuracy; and ensuring effective, consistent and accurate workflow. Technical Skills: Comprehensive knowledge of research methodology; proficient applying appropriate data analysis processes; knowledge of managed care principles and methods; knowledge in the application of clinical criteria; proficient with Microsoft Word, Excel, and PowerPoint.
Lead Reviewing Physician Consultant (Bid) MaximusLead Reviewing Physician Consultant (Bid)Cheyenne, WYFull timeAfter completing all research, the physician must write a case rationale in the correct format that introduces the question at hand, summarizes the correct guideline, analyses the pertinent case details related to the guideline, and then make a final determination as to the medical necessity of the requested service. Maximus compensation is based on various factors including but not limited to job location, a candidate's education, training, experience, expected quality and quantity of work, required travel (if any), external market and internal value analysis including seniority and merit systems, as well as internal pay alignment.
Mental Health Reviewing Consultant (Bid) MaximusMental Health Reviewing Consultant (Bid)Cheyenne, WYFull timeMaximus compensation is based on various factors including but not limited to job location, a candidate's education, training, experience, expected quality and quantity of work, required travel (if any), external market and internal value analysis including seniority and merit systems, as well as internal pay alignment. - After completing all research, the physician must write a case rationale in the correct format that introduces the question at hand, summarizes the correct guideline, analyses the pertinent case details related to the guideline, and then make a final determination as to the medical necessity of the requested service.
Alternate Vision Reviewing Physician Consultant (BID) MaximusAlternate Vision Reviewing Physician Consultant (BID)Cheyenne, WYFull timeMaximus compensation is based on various factors including but not limited to job location, a candidate's education, training, experience, expected quality and quantity of work, required travel (if any), external market and internal value analysis including seniority and merit systems, as well as internal pay alignment. - Maintain working knowledge of Office of Personnel Management (OPM) medical and suitability policies and ensure all consultations reflect current clinical best practices, regulatory requirements, and program objectives.
Behavioral Health Medical Director - AI Policy & Governance CVS Health CorpBehavioral Health Medical Director - AI Policy & GovernanceWY$174,070–$374,920 / yearRole summary: The Behavioral Health (BH) Medical Director (MD) for AI Policy & Governance provides clinical leadership to ensure artificial intelligence (AI)including predictive models and generative AIis designed, validated, implemented, and monitored in ways that are clinically sound, ethical, safe, compliant, and equitable. -Ensure equitable performance across populations (e.g., depending on how model was trained, training data may not always be representative), identify and mitigate algorithmic bias in care decisions; align AI deployment with organizational values and patient trust.