AsceticVoyage · 1 day ago
Epic Tapestry UM Analyst
United States
Contract
Remote
Mid, Senior Level
3+ years expAsceticVoyage is seeking an experienced Epic Tapestry Utilization Management Analyst to design, build, optimize, and support UM processes focused on authorizations and referrals. The role involves collaborating with various teams to ensure efficient and compliant UM determinations that enhance member and provider experiences.
Information Technology & Services
Hiring Manager
Mayank Mishra
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
Qualification
Required
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
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
Company
AsceticVoyage
🔹 Freelance Recruiter | Talent Acquisition Specialist | Helping Companies Find the Right Fit 🔹 With a passion for connecting people and opportunities, I help startups, SMEs, and growing businesses find top talent across industries.
0-1 employees
Funding
Current Stage
Early StageCompany data provided by crunchbase