72 general medicine jobs found in Augusta, ME

Position Overview The Senior Clinical Consultant, Cardiology shall be responsible for providing clinical consulting for the project, report configuration, workflow analysis, end-to-end testing, and go-live support to the implementation projects. In addition, provide clinical support for development, sales and company team members with respect to the use of the company's products and serving as a consultant on behalf of customers and company personnel in compliance with the company's quality procedures. Company Overview At FUJIFILM Healthcare Americas Corporation, we're on a mission to innovate for a healthier world, and we need passionate, driven people like you to help us get there. Our cutting-edge healthcare solutions span diagnostic imaging, enterprise imaging, endoscopic and surgical imaging, as well as in-vitro diagnostics. But we don't stop at healthcare; our Non-Destructive Testing (NDT) team harnesses advanced radiography solutions to keep transportation...

Your Future Evolves Here Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones. Evolent employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done. We believe that people do their best work when they're supported to live their best lives, and when they feel welcome to bring their whole selves to work. That's one reason why diversity and inclusion are core to our business. Join Evolent for the mission. Stay for the culture. What You'll Be Doing: As a FMD, you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients' lives, in a non-clinical environment. You...

Company : Highmark Health Job Description : JOB SUMMARY This role delivers high-impact analytics and insights focused on Social Determinants of Health (SDOH) to support enterprise strategy and population health initiatives. The position contributes to the development and evolution of enterprise SDOH dashboards and self-service analytic tools, with a focus on analytical rigor, scalability, and alignment to high-value use cases. The incumbent serves as a consultative analytic partner to the Enterprise SDOH team, collaborating to refine analytic questions and translate complex needs into clear, actionable analytic approaches. As reporting capabilities mature, this role will support advanced analysis of varied and multilevel data in exploratory, evaluative, and research-adjacent analytic work, and development of insights that inform program design and strategic decision-making. ESSENTIAL RESPONSIBILITIES Supports and leads the design, development, execution,...

Company : Highmark Inc. Job Description : JOB SUMMARY This role supports the Medical Policy team by bringing medical director level expertise, experience and knowledge to the team. They support the full-cycle ownership of commercial and Medicare Advantage medical policies, both developed internally and by vendors. This includes the writing of clinical criteria based on research, engagement of clinical and non-clinical team members for operational guidelines. The incumbent must have an understanding of medical coding (ICD-10, CPT, HCPS) as medical coding based off policy criteria falls within their scope. In addition to developing new policies, the incumbent ensures all existing medical policies, in their scope, are in accordance with NCQA and/or CMS requirements. The incumbent may be required to address escalated inquiries brought forward by internal/external partners. Conducts peer reviews as part of the quality review process. In addition to policy ownership, the...

Company : Highmark Inc. Job Description : JOB SUMMARY This job is directly responsible for the value creation, impact and cost control, and fiscal/ROI targets as set by the Organization. This includes revenue stream outcomes and engagement of primary care providers (PCP) and facilities enrolled in the Organization's value based reimbursement programs, clinical care models, and continuous improvement models. The incumbent applies subject matter expertise in clinical pharmacy, pharmacy formulary, pharmacy benefit design, pharmacy policy, medical drug policy, therapeutic alternatives, medication adherence strategies, Medication Therapy Management, utilization management, immunizations, specialty pharmacy, Medicare Stars, and Medicaid HEDIS to strategies designed to promote the Organization's value based reimbursement PCP and facility programs. The incumbent acts as a highly skilled subject matter expert (SME) in the Organization's value based reimbursement PCP and...

Become a part of our caring community and help us put health first Become a part of our caring community Humana is advancing its enterprise personalization strategy to deliver timely, relevant, and empathetic experiences across the member journey. As the Lead Product Manager for NBA Decisioning, within the Marketing Organization you will own the strategy, design, and governance of our Next Best Action capability-enabling real-time decisioning across channels, lines of business, and customer touchpoints to deliver key marketing objectives. Success in this role means transforming NBA into a mature technical capability that delivers measurable impact across Humana's member experience. You'll lead adoption across teams and channels, define how decisioning logic is structured to enable personalized, real-time decisioning that improves engagement, conversion, and health outcomes. Your work will enable scalable integration with enterprise platforms and data sources and provide...

Your Future Evolves Here Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones. Evolent employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done. We believe that people do their best work when they're supported to live their best lives, and when they feel welcome to bring their whole selves to work. That's one reason why diversity and inclusion are core to our business. Join Evolent for the mission. Stay for the culture. What You'll Be Doing: As an Occupational Therapist, Clinical Reviewer you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients...

Become a part of our caring community and help us put health first Job Title: CenterWell Senior Associate, Digital Department: CenterWell Digital Marketing Location: Remote Reporting To: Associate Director, CenterWell Digital Marketing Become a part of our caring community and help us put health first. At CenterWell, we're transforming healthcare by delivering integrated, personalized experiences that put patients at the center of care. As a leading provider of senior-focused primary care, home health services, and pharmacy solutions-including specialty, mail order, and retail, we're committed to whole-person wellness: physical, emotional, and social. We're seeking a strategic digital marketing associate to help elevate CenterWell's digital presence and connect more seniors with personalized care. As Senior Associate, Digital you'll own and execute digital strategies across key owned channels-website, email, SMS, and organic social-to drive awareness, engagement,...

Become a part of our caring community and help us put health first We are seeking a seasoned Lead Software Engineer to architect and deliver the foundational services that enable real time recommendations to become dependable, auditable, and scalable outcomes. In this position, you will own the design and implementation of the State Machine (managing authoritative state and legal transitions) and Transactional Outbox (ensuring exactly-once intent emission for downstream consumers). Your solutions must be robust, traceable, and maintain high performance under significant concurrency and latency demands. This role is hands-on, combining technical leadership with active engineering: you will architect systems, set technical standards, mentor peers, and collaborate closely across platform, data, and product teams. Key Responsibilities State Machine Architecture Define execution lifecycles and business states, implementing strict legal transition guards....

Become a part of our caring community and help us put health first The Grievances & Appeals Representative 2 manages client denials and concerns by conducting a comprehensive analytic review of clinical documentation to determine if an a grievance, appeal or further request is warranted and then delivers final determination based on trained skillsets and/or partnerships with clinical and other Humana parties. The Grievances & Appeals Representative 2 performs varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically works on semi-routine assignments. The Grievances & Appeals Representative 2 assists members, via phone or face to face, further/support quality related goals. Investigates and resolves member and practitioner issues. Decisions are typically focus on interpretation of area/department policy and methods for completing assignments. Works within defined parameters to identify work...

ROLE SUMMARY At Pfizer Oncology, we are committed to "Outdo Cancer" by advancing transformative medicines wherever we can make a profound difference in the lives of patients. Today, Pfizer Oncology has an industry-leading pipeline that includes the combined legacy Pfizer and Seagen portfolio across breast, genitourinary, hematology-oncology and thoracic therapeutic areas. Core to Pfizer's Hematology-Oncology strategy is long-term leadership in multiple myeloma. We aim to position Elrexfio as the bispecific of choice and deliver a successful lifecycle program that has the potential to address the needs of more patients earlier in the treatment journey. The Team Lead role provides an excellent opportunity to lead a talented team of global marketing colleagues focused on driving Elrexfio's global commercial potential and addressing the significant unmet needs of multiple myeloma patients. In Global Marketing, we translate science into value for patients. Our remit is to own...

Become a part of our caring community and help us put health first We are seeking an accomplished Senior Software Engineer to design, implement, and operate mission-critical stateful services that form the backbone of real-time, automated decisioning and personalization platforms. These systems are responsible for maintaining authoritative state, orchestrating lifecycle transitions, and ensuring reliable downstream effects-often in high-concurrency, low-latency environments. This position is ideal for engineers with a strong grasp of state machines, idempotency, distributed systems, and "exactly-once" execution semantics. You will also employ advanced AI-assisted and agentic engineering tools to drive correctness, velocity, resilience, and scalability. Key Responsibilities State Machine Architecture & Implementation Design, build, and maintain explicit state machines governing: Lifecycle transitions (e.g., open ? in progress ? completed ? suppressed)...

Become a part of our caring community and help us put health first We are seeking a Lead Machine Learning Engineer to architect, develop, and manage machine learning systems that enable real-time, personalized decision-making across digital and assisted channels. These platforms leverage predictive modeling, optimization algorithms, and contextual data to identify the most relevant next action for each individual-at scale, with minimal latency, and with a strong emphasis on reliability and explainability. This position centers on production machine learning engineering. You will lead the creation of ML pipelines, online inference services, and decision-time scoring logic, utilizing AI-assisted and agentic solutions to enhance development velocity, model quality, and operational effectiveness. Key Responsibilities ML System Design & Architecture Design and manage end-to-end machine learning systems, including: Feature engineering and reuse strategies...

Become a part of our caring community and help us put health first We are building an innovative Next Best Action (NBA) platform designed to power personalized engagement, gamified incentives, and advanced agentic AI decision-making across the enterprise. As Lead Technical Product Manager (PM-T), you will shape the product vision, define the roadmap, and oversee delivery of the NBA platform. Your responsibilities include integrating data, predictive models, and APIs to enable real-time decisioning, rewards, and AI-driven experiences throughout digital and service channels. You will work in close partnership with engineering, data science, AI, and business teams to develop solutions that drive improvements in Star Ratings, expedite HEDIS gap closure, and enhance CAHPS satisfaction scores. Key Responsibilities Product Vision & Strategy Define and drive the NBA platform strategy to deliver data-driven personalization and intelligent engagement for all...

Become a part of our caring community and help us put health first Become a part of our caring community and help us put health first Are you detail-oriented and passionate about protecting brand integrity? As the Associate, Enterprise Initiatives & Brand Governance, you'll support the development and execution of marketing strategies that span Humana's enterprise and brand portfolio as well as the implementation Humana's brand standards across all marketing and communication touchpoints. Role Responsibilities Support enterprise-wide marketing initiatives , contributing to the planning and execution of programs that span multiple brands, business units, and strategic priorities. Contribute to annual planning and intake processes , helping create and refine annual plans, business intake briefs, and marketing briefs. Partner cross-functionally to enable cohesive storytelling , working with Brand Strategy, Product Marketing, Corporate...

Become a part of our caring community and help us put health first The Clinical Pharmacist Lead-Florida monitors drug development pipeline, and medical literature, while providing clinical support for internal stakeholders. Utilizes broad understanding of managed care and PBM knowledge to develop, and/or implement strategies and programs to mitigate cost trend and improve health outcomes. The Clinical Pharmacist Lead works on problems of diverse scope and complexity ranging from moderate to substantial. The Clinical Pharmacist Lead- Florida develops, maintains, and/or operationalizes formularies related to coverage, utilization management edits, or clinical coverage policies for pharmacy and medical administered drug products. Conducts analysis on drug utilization trends to evaluate and inform formulary strategies. Collaborates on research projects and develops proposals for research projects. Develops corporate communications to be shared with senior leadership. Supports...

Become a part of our caring community and help us put health first The Director, Corporate Communications develops and coordinates lines of communication outside the organization. The Director, Corporate Communications requires an in-depth understanding of how organization capabilities interrelate across the function or segment. The Director of CenterWell External Communications in Corporate Communications works closely with senior executives in this critical businesses on external communications, corporate reputation, media and public relations. The director also provides strategic advice and guidance to an internal team of Humana associates, as well as external public relations agency partners, to ensure Corporate Communications is successfully helping to position each of these businesses as they pursue performance and growth goals. Use your skills to make an impact This is NOT a Marketing position Required Qualifications Bachelor's degree in...

Become a part of our caring community and help us put health first We are seeking a Lead Automation Engineer to establish and guide a sophisticated quality and test automation function for a large-scale, real-time decisioning platform. This platform delivers personalized recommendations and actions across digital, call-center, and marketing channels through a combination of stateful logic, business rules, and machine learning. This position extends beyond conventional test automation. You will spearhead the adoption of AI-driven and agentic automation methods to validate intricate decision logic, broaden coverage for edge cases, and enhance system confidence where accuracy, explainability, and reliability are essential. Key Responsibilities Automation Strategy & Architecture Develop and own the comprehensive automation strategy for a distributed, real-time decisioning platform, including: API and service-level validation Stateful workflow and...

Your Future Evolves Here Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones. Evolent employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done. We believe that people do their best work when they're supported to live their best lives, and when they feel welcome to bring their whole selves to work. That's one reason why diversity and inclusion are core to our business. Join Evolent for the mission. Stay for the culture. What You'll Be Doing: As a Field Medical Director, Physical Medicine and Rehab you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in...

Become a part of our caring community and help us put health first The Director, Next Best Action (NBA) Platform, is accountable for architecting and expanding an enterprise-level, real-time decisioning platform that enables personalized, compliant, and measurable interactions across digital, call-center, and marketing channels. This position provides both technical and delivery leadership in the areas of decisioning, state management, business rules, machine learning integration, and channel activation, ensuring that all decisions are rapid, transparent, governed, and continuously optimized. Primary Responsibilities Platform & Architecture Leadership Oversee the comprehensive architecture of real-time decisioning, including: Decision orchestration services State management and lifecycle tracking Eligibility and policy evaluation Action and offer metadata management Integration of ML scoring and ranking Define clear...

Become a part of our caring community and help us put health first Become a part of our caring community and help us put health first Are you energized by connecting dots across brands and business units? As the Senior Associate, Enterprise & Cross Brand Initiatives, you'll support the development and execution of marketing strategies that span Humana's enterprise and brand portfolio. You'll help ensure consistency, cohesion, and strategic alignment across initiatives that impact multiple lines of business and the broader enterprise. Role Responsibilities Support the planning, development, and execution of enterprise-wide marketing initiatives that span multiple brands, business units or enterprise efforts, ensuring cohesive storytelling and brand alignment. Collaborate closely with Brand Strategy, Product Marketing, and Corporate Communications to ensure integration, consistency, and clarity across all enterprise and cross-brand marketing efforts....

Your Future Evolves Here Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones. Evolent employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done. We believe that people do their best work when they're supported to live their best lives, and when they feel welcome to bring their whole selves to work. That's one reason why diversity and inclusion are core to our business. Join Evolent for the mission. Stay for the culture. What You'll Be Doing: The Nurse Practitioner/Physician Assistant (ARNP/NP/PA) Vascular Surgey is responsible for support and assistance for all cardiology administrative and clinical utilization...

At WelbeHealth, we serve our communities' most vulnerable seniors through shared intention, pioneering spirit, and the courage to love. These core values and our participant-focus lead the way no matter what. The VP, Federal Government Affairs is accountable for developing and implementing bold federal advocacy strategies by directing contracted lobbyists and other consultants to advance the WelbeHealth PACE mission. The strategies will include cultivating effective relationships with regulators, elected officials, member associations, and other relevant key stakeholders. In addition, this role will proactively influence, initiate, monitor, and track policy changes relevant to WelbeHealth. This role is different because the VP, Federal Government Affairs at WelbeHealth: Directly shapes the future of the PACE model at the federal level, partnering with CMS and policymakers to influence regulations that determine how care is delivered to our most vulnerable seniors,...

At WelbeHealth, we are transforming the reality of senior care by providing an all-inclusive healthcare option (PACE) to the most vulnerable senior population while serving as a care provider and care plan to those individuals we serve. Our Health Plan Services team helps ensure excellent care delivery for our participants, and the Claims Audit Analyst plays a pivotal role in ensuring timely and accurate pre-payment or denial of claims while meeting federal/state regulations, provider agreements terms, and/or company policies and procedures. Essential Job Duties: Review processed claims for accuracy prior to payment while maintaining acceptable levels of claim's aged inventory by verifying various aspects of the system and claim Complete and maintain detailed documentation of audit findings which include decision methodology, system or processing errors, and monetary discrepancies Move claims free of processing errors through for full adjudication and...