Tapestry UM Analyst
Location
United States
Posted
18 days ago
Salary
Not specified
No structured requirement data.
Job Description
Job Requirements
- Epic Tapestry Utilization Management Certification (active).
- 3–5+ years hands-on Epic Tapestry UM build/support experience specifically in UM authorizations and referrals.
- Demonstrated experience implementing and supporting Tapestry Care Link for external provider/referral workflows.
- Proven ability to configure UM routing rules, workqueues, decisioning tools, letters/notifications, and SLAs.
- Solid understanding of payer operations and UM regulations (e.g., CMS timelines, state TATs, HIPAA, NCQA), including denial and appeal pathways.
- Experience with testing lifecycle (unit → SIT → UAT), defect management, and release/hypercare processes.
- Strong analytical skills; proficiency with SQL/Clarity/Caboodle/SlicerDicer (read/interpret) and operational reporting for UM KPIs.
- Effective communicator with the ability to translate business requirements into system design; strong documentation and presentation skills.
- Additional Epic credentials (e.g., Tapestry Benefits/Contracts, Claims, Care Management, Member Enrollment, Security).
- Experience with EDI X12 278/275 workflows and payer integration patterns.
- Familiarity with industry clinical criteria tools (InterQual, MCG) and attachment management.
- Exposure to provider portal strategies and delegated entity oversight.
- Clinical background (e.g., RN) or strong experience partnering with clinical reviewers and Medical Directors.
- Prior experience in payers/health plans, delegated risk provider groups, or large IDNs with plan operations.
- Key Responsibilities
- Configure and optimize Tapestry UM workflows for prior authorizations (e.g., medical, behavioral health, pharmacy-to-medical crossovers) and referrals (in- and out-of-network), including routing rules, WQs, templates, smart text, decision trees, and notification logic.
- Leverage Tapestry Care Link for external provider access—set up roles, security, workflows, documentation tools, and training materials to support referring providers, delegated entities, and partners.
- Align UM workflows with benefit plan configuration, provider network tiering, care management touchpoints, and claims adjudication.
Benefits
- This is a remote position.
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