Job Summary (List Format): Epic Tapestry Utilization Management Analyst
- Design, build, and optimize Epic Tapestry Utilization Management (UM) workflows focused on authorizations and referrals.
- Configure and support prior authorization and referral processes for medical, behavioral health, and pharmacy-to-medical crossovers.
- Develop and maintain routing rules, work queues, decision trees, templates, smart texts, and notification logic within Epic Tapestry UM.
- Implement and support Tapestry Care Link for external provider access, including roles, security, workflows, documentation tools, and training.
- Align UM workflows with benefit plan configuration, provider network tiering, care management touchpoints, and claims adjudication.
- Collaborate with UM leadership, clinical reviewers, provider relations, care management, claims, and integration teams to ensure compliant and efficient UM determinations.
- Ensure solutions support regulatory compliance, reduce administrative burden, and improve member and provider experience.
- Utilize strong analytical skills and tools (e.g., SQL, Clarity, Caboodle, SlicerDicer) to support operational reporting and UM KPIs.
- Participate in the testing lifecycle (unit, SIT, UAT), defect management, and release/hypercare processes.
- Translate payer and network operations needs into scalable Epic solutions through effective communication and documentation.E
Expert Technology Services