Epic Tapestry Utilization Management
About The Position
The Epic Tapestry Utilization Management (UM) Analyst is responsible for the design, configuration, implementation, optimization, and ongoing support of Epic Tapestry Utilization Management functionality. This role partners with Utilization Management, Care Management, Case Management, Provider Relations, Medical Directors, Claims, and IT teams to streamline prior authorization and referral workflows while ensuring compliance with CMS, NCQA, HIPAA, and state regulatory requirements. The analyst serves as the subject matter expert for Epic Tapestry UM, translating operational requirements into scalable Epic solutions that improve efficiency, reduce administrative burden, and enhance member and provider experiences.
Requirements
- Design, build, configure, and maintain Epic Tapestry Utilization Management workflows.
- Configure prior authorization, referral, and service authorization functionality.
- Build and maintain work queues, routing rules, decision trees, SmartTools, templates, SmartText, notifications, and correspondence workflows.
- Configure auto-status logic, event processing, authorization rules, and workflow automation.
- Partner with operational leaders to analyze business requirements and develop future-state workflows.
- Collaborate with clinical reviewers, provider relations, care management, claims, and revenue cycle teams to optimize end-to-end UM processes.
- Configure Tapestry Care Link workflows for external providers, delegated entities, and network partners.
- Support provider portal workflows, security roles, and external user access.
- Ensure UM workflows align with benefit plans, provider networks, care management, and claims adjudication processes.
- Participate in design sessions, workflow validation, and solution recommendations.
- Develop functional specifications and configuration documentation.
- Perform system testing including unit, integrated, regression, and user acceptance testing (UAT).
- Troubleshoot application issues, perform root cause analysis, and coordinate issue resolution.
- Support Epic upgrades, enhancements, optimization initiatives, and production support.
- Participate in go-live planning, command center support, and post-production stabilization.
- Develop reporting requirements and collaborate with reporting teams to support operational KPIs.
- Ensure compliance with CMS, NCQA, URAC, HIPAA, and state regulatory turnaround time requirements.
Responsibilities
- Design, build, configure, and maintain Epic Tapestry Utilization Management workflows.
- Configure prior authorization, referral, and service authorization functionality.
- Build and maintain work queues, routing rules, decision trees, SmartTools, templates, SmartText, notifications, and correspondence workflows.
- Configure auto-status logic, event processing, authorization rules, and workflow automation.
- Partner with operational leaders to analyze business requirements and develop future-state workflows.
- Collaborate with clinical reviewers, provider relations, care management, claims, and revenue cycle teams to optimize end-to-end UM processes.
- Configure Tapestry Care Link workflows for external providers, delegated entities, and network partners.
- Support provider portal workflows, security roles, and external user access.
- Ensure UM workflows align with benefit plans, provider networks, care management, and claims adjudication processes.
- Participate in design sessions, workflow validation, and solution recommendations.
- Develop functional specifications and configuration documentation.
- Perform system testing including unit, integrated, regression, and user acceptance testing (UAT).
- Troubleshoot application issues, perform root cause analysis, and coordinate issue resolution.
- Support Epic upgrades, enhancements, optimization initiatives, and production support.
- Participate in go-live planning, command center support, and post-production stabilization.
- Develop reporting requirements and collaborate with reporting teams to support operational KPIs.
- Ensure compliance with CMS, NCQA, URAC, HIPAA, and state regulatory turnaround time requirements.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
