We are seeking an experienced Epic Tapestry Utilization Management (UM) Analyst to design, build, optimize, and support UM processes focused on authorizations and referrals. The ideal candidate is Epic Tapestry UM Certified, has hands-on experience with Tapestry Care Link, and excels at translating payer and network operations requirements into scalable Epic solutions.

This role partners closely with UM leadership, clinical reviewers, provider relations, care management, claims, and integration teams to ensure compliant, efficient, and transparent UM determinations that reduce administrative burden and improve both member and provider experience.

Key Responsibilities

Solution Design & Build

• Configure and optimize Epic Tapestry UM workflows for:
  • Prior authorizations (medical, behavioral health, pharmacy-to-medical crossovers)
  • Referrals (in-network and out-of-network)
• Build and maintain:
  • Routing rules
  • Workqueues (WQs)
  • Templates, SmartText, and decision trees
  • Notification and correspondence logic
• Implement and support Tapestry Care Link for external providers, including:
  • Role and security setup
  • End-to-end provider workflows
  • Documentation tools and job aids
  • Training materials for referring providers, delegated entities, and partners
• Ensure UM workflows align with:
  • Benefit plan configuration
  • Provider network tiering
  • Care management workflows
  • Claims adjudication processes

Operational & Compliance Support

• Support UM determinations in compliance with:
  • CMS requirements
  • State turnaround time (TAT) regulations
  • HIPAA and NCQA standards
• Configure denial, reconsideration, and appeal pathways in Epic
• Partner with business stakeholders to ensure SLA adherence and accurate UM decisioning

Testing, Reporting & Support

• Participate in the full testing lifecycle:
  • Unit testing
  • System Integration Testing (SIT)
  • User Acceptance Testing (UAT)
• Support defect triage, release management, and post‑go‑live hypercare
• Analyze and interpret UM data using:
  • SQL
  • Clarity
  • Caboodle
  • SlicerDicer
• Support operational and performance reporting for UM KPIs

Required Qualifications

• Epic Tapestry Utilization Management Certification (active)
• 3–5+ years of hands-on Epic Tapestry UM build and support experience, specifically in:
  • UM authorizations
  • UM referrals
• Demonstrated experience implementing and supporting Tapestry Care Link
• Strong working knowledge of:
  • UM routing rules
  • Workqueues
  • Decision support tools
  • Letters, notifications, and SLAs
• Solid understanding of payer operations and UM regulations, including:
  • CMS timelines
  • State-specific TAT requirements
  • Denial and appeal processes
• Strong analytical and problem-solving skills
• Excellent communication skills with the ability to translate business requirements into technical designs
• Proven documentation and presentation skills