Utilization Management (UM) Analyst

This is a fully remote position, open to applicants in United States.

📋 Description

• Design, develop, configure, test, and maintain the functionality of Epic Tapestry Utilization Management.

• Assist in UM workflows, which include prior authorizations, referrals, inpatient admissions, concurrent reviews, and determinations of medical necessity.

• Configure and enhance authorization workflows, review processes, workqueues, and decision-support functionalities.

• Collaborate with clinical and operational stakeholders to identify opportunities for workflow enhancement and translate business requirements into Epic solutions.

• Support the implementation, upgrades, enhancements, integrated testing, and go-live activities of Epic Tapestry.

• Troubleshoot application issues, resolve defects, and provide continuous production support.

• Work in conjunction with Tapestry Claims, Membership, Provider Management, and clinical applications teams to ensure seamless integrated workflows.

• Support compliance with regulatory requirements related to utilization management, including CMS and NCQA standards.

• Develop functional specifications, testing scenarios, and system documentation.

• Provide end-user assistance and facilitate knowledge transfer to operational teams.

⛳️ Requirements

• Epic Tapestry Utilization Management certification is required.

• Hands-on experience with the build, configuration, testing, and optimization of Epic Tapestry UM.

• Strong comprehension of managed care operations, including prior authorization, referrals, and utilization review processes.

• Experience in supporting Epic implementations, upgrades, and production environments.

• Ability to analyze complex workflows, troubleshoot technical issues, and propose improvements.

• Excellent communication skills and experience collaborating with clinical, operational, and IT stakeholders.

• Must be legally authorized to work in the United States.

🏝️ Benefits

• Remote work is permitted.

• Equal opportunity employment.

• A diverse and inclusive workforce.