Epic Tapestry UM Analyst

Vytwo; Poland; Sur place; PLN 359 583 - 467 457; Plein temps

Résumé du poste

Vytwo is looking for an experienced Epic Tapestry Utilization Management Analyst for a remote position. The ideal candidate will be Epic Tapestry UM Certified and possess 3-5+ years of hands-on experience in UM authorizations and referrals. Responsibilities include configuring Tapestry UM workflows, supporting Tapestry Care Link, and ensuring compliance with payer operations. Strong analytical skills and effective communication are essential. This position offers a flexible work environment focused on improving member and provider experience.

Qualifications

• Epic Tapestry Utilization Management Certification must be active.
• 3-5+ years of experience specifically in UM authorizations and referrals.
• Solid understanding of payer operations and UM regulations.

Responsabilités

• Configure and optimize Tapestry UM workflows.
• Leverage Tapestry Care Link for external provider access.
• Align UM workflows with benefit plan configuration and claims adjudication.

Connaissances

Epic Tapestry Utilization Management Certification

3-5+ years of Epic Tapestry UM build/support experience

Experience with Tapestry Care Link

Payer operations and UM regulations knowledge

Strong analytical skills (SQL/Clarity/Caboodle/SlicerDicer)

Effective communication skills

Description du poste

Remote Work

Must be authorized to work in USA.

Job Description

We are seeking an experienced Epic Tapestry Utilization Management Analyst to design, build, optimize, and support UM processes focused on authorizations and referrals. The ideal candidate is Epic Tapestry UM Certified, has practical experience with Tapestry Care Link, and is adept at translating payer and network operations needs into scalable Epic solutions. You will partner with UM leadership, clinical reviewers, provider relations, care management, claims, and integration teams to enable compliant, efficient, and transparent UM determinations that reduce administrative burden and improve member and provider experience.

Preferred

• 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

Solution Design & Build

• 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.

Required skills

• 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 to SIT to 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.

This is a remote position.