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 with Utilization Management workflows, including prior authorizations, referrals, inpatient admissions, concurrent reviews, and medical necessity evaluations.

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

• Collaborate with clinical and operational stakeholders to pinpoint workflow enhancements and convert business requirements into Epic solutions.

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

• Diagnose application issues, rectify defects, and provide continuous production support.

• Collaborate with Tapestry Claims, Membership, Provider Management, and clinical applications teams to ensure cohesive workflows.

• Adhere to regulatory and compliance mandates related to utilization management, including CMS and NCQA standards.

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

• Offer end-user support and facilitate knowledge transfer to operational teams.

⛳️ Requirements

• Epic Tapestry Utilization Management certification is mandatory.

• Practical experience with Epic Tapestry UM build, configuration, testing, and optimization is essential.

• In-depth knowledge of managed care operations, prior authorization, referrals, and utilization review processes.

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

• Capability to analyze complex workflows, troubleshoot technical challenges, and suggest enhancements.

• 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 options available.

• Commitment to equal opportunity employment.

• Foster a diverse and inclusive workforce.