Epic Tapestry Utilization Management Analyst

Judge Group

(remote)

JOB DETAILS
SALARY
$60–$70 Per Year
SKILLS
Acceptance Testing, Adjudication, Analysis Skills, Apache Tapestry, Behavioral Health, Bug Tracking/Defect Management, Business Skills, Claims Processing, Communication Skills, Compensation and Benefits, Content Management Systems (CMS), Decision Support, Documentation, Epic Certification, Epic Tapestry, HIPAA (Health Insurance Portability and Accountability Act), Integration Testing, Leadership, Maintain Compliance, National Committee for Quality Assurance (NCQA), Network Administration/Management, Operational Support, Patient Care Authorizations, Performance Analysis, Performance Metrics, Pharmacy, Problem Solving Skills, Provider Relations, Regulations, Release Management/Engineering, Requirements Management, SQL (Structured Query Language), Service Level Agreement (SLA), Short Messaging Service (SMS), System Integration (SI), System Test, Technical/Engineering Design, Unit Test, Utilization Management
POSTED
30+ days ago
Location: REMOTE
Salary: $60.00 USD Hourly - $70.00 USD Hourly
Description: Our client is currently seeking a Epic Tapestry Utilization Management Analyst


This job will have the following responsibilities:

    We are seeking an experienced Epic Tapestry Utilization Management (UM) Analyst to design, build, optimize, and support UM processes focused on authorizations and referrals. The ideal candidate is Epic Tapestry UM Certified, has hands-on experience with Tapestry Care Link, and excels at translating payer and network operations requirements into scalable Epic solutions.

    This role partners closely with UM leadership, clinical reviewers, provider relations, care management, claims, and integration teams to ensure compliant, efficient, and transparent UM determinations that reduce administrative burden and improve both member and provider experience.


    Key Responsibilities

    Solution Design & Build

    • Configure and optimize Epic Tapestry UM workflows for:
      • Prior authorizations (medical, behavioral health, pharmacy-to-medical crossovers)
      • Referrals (in-network and out-of-network)
    • Build and maintain:
      • Routing rules
      • Workqueues (WQs)
      • Templates, SmartText, and decision trees
      • Notification and correspondence logic
    • Implement and support Tapestry Care Link for external providers, including:
      • Role and security setup
      • End-to-end provider workflows
      • Documentation tools and job aids
      • Training materials for referring providers, delegated entities, and partners
    • Ensure UM workflows align with:
      • Benefit plan configuration
      • Provider network tiering
      • Care management workflows
      • Claims adjudication processes

    Operational & Compliance Support

    • Support UM determinations in compliance with:
      • CMS requirements
      • State turnaround time (TAT) regulations
      • HIPAA and NCQA standards
    • Configure denial, reconsideration, and appeal pathways in Epic
    • Partner with business stakeholders to ensure SLA adherence and accurate UM decisioning

    Testing, Reporting & Support

    • Participate in the full testing lifecycle:
      • Unit testing
      • System Integration Testing (SIT)
      • User Acceptance Testing (UAT)
    • Support defect triage, release management, and post‑go‑live hypercare
    • Analyze and interpret UM data using:
      • SQL
      • Clarity
      • Caboodle
      • SlicerDicer
    • Support operational and performance reporting for UM KPIs

    Required Qualifications

    • Epic Tapestry Utilization Management Certification (active)
    • 3–5+ years of hands-on Epic Tapestry UM build and support experience, specifically in:
      • UM authorizations
      • UM referrals
    • Demonstrated experience implementing and supporting Tapestry Care Link
    • Strong working knowledge of:
      • UM routing rules
      • Workqueues
      • Decision support tools
      • Letters, notifications, and SLAs
    • Solid understanding of payer operations and UM regulations, including:
      • CMS timelines
      • State-specific TAT requirements
      • Denial and appeal processes
    • Strong analytical and problem-solving skills
    • Excellent communication skills with the ability to translate business requirements into technical designs
    • Proven documentation and presentation skills

    By providing your phone number, you consent to: (1) receive automated text messages and calls from the Judge Group, Inc. and its affiliates (collectively "Judge") to such phone number regarding job opportunities, your job application, and for other related purposes. Message & data rates apply and message frequency may vary. Consistent with Judge's Privacy Policy, information obtained from your consent will not be shared with third parties for marketing/promotional purposes. Reply STOP to opt out of receiving telephone calls and text messages from Judge and HELP for help.


    Contact: bpant@judge.com
    This job and many more are available through The Judge Group. Find us on the web at www.judge.com

    About the Company

    J

    Judge Group

    The Judge Group Inc., is a leading professional services firm specializing in talent, technology, and learning solutions. We consult, staff, train, and solve. Through our work we make people and organizations better. Our services are successfully delivered through a network of more than 30 offices across the United States, Canada, and India.

    The Judge Group is proud to partner with the best and brightest companies in business today, including over 60 of the Fortune 100. We serve organizations in financial services, healthcare, life sciences, insurance, government (including aerospace and defense), manufacturing, and technology and telecommunications. If you would like to learn more about The Judge Group visit www.judge.com or call toll free (800) 360-4474.

    COMPANY SIZE
    5,000 to 9,999 employees
    INDUSTRY
    Computer/IT Services
    FOUNDED
    1970
    WEBSITE
    https://www.judge.com