Epic Tapestry UM Analyst - 100% Remote

We are seeking an experienced Epic Tapestry Utilization Management (UM) Analyst to design, build, optimize, and support UM workflows focused on prior authorizations and referrals. This role partners closely with UM leadership, clinical reviewers, provider relations, care management, claims, and integration teams to deliver compliant, efficient, and transparent UM determinations that reduce administrative burden and improve both member and provider experience.

The ideal candidate is Epic Tapestry UM Certified (preferred), has hands-on experience with Tapestry Care Link, and brings strong payer-side expertise, translating operational and regulatory requirements into scalable Epic solutions.

Solution Design & Build

• Design, configure, and optimize Epic Tapestry UM workflows for prior authorizations (medical, behavioral health, pharmacy-to-medical crossovers) and referrals (in-network and out-of-network).

• Configure routing rules, workqueues (WQs), templates, SmartText, decision trees, letters, and notification logic to support UM determinations and SLAs.

• Implement and support Tapestry Care Link to enable secure external provider access, including role/security setup, workflows, documentation tools, and training materials.

• Align UM workflows with benefit plan configuration, provider network tiering, care management touchpoints, and claims adjudication.

• Partner with cross-functional stakeholders to ensure UM workflows support regulatory compliance, operational efficiency, and provider usability.

Testing, Delivery & Optimization

• Support the full testing lifecycle, including unit testing, SIT, UAT, defect management, releases, and hypercare.

• Develop and execute test scenarios for UM authorizations, referrals, and payer integrations.

• Analyze and interpret operational and reporting data to support UM KPIs and continuous improvement initiatives.

Required Experience/Skills:

• 3-5+ years of hands-on experience building and supporting Epic Tapestry Utilization Management systems, with a focus on authorizations and referrals.

• Experience implementing and supporting Tapestry Care Link for external provider and referral workflows.

• Proven expertise in configuring UM routing rules, workqueues, decision logic, letters, notifications, and SLAs.

• Strong understanding of payer operations and UM regulations, including CMS timelines, state TATs, HIPAA, NCQA, and denial/appeal pathways.

• Experience across the full testing and release lifecycle (unit testing through hypercare).

• Strong analytical skills with the ability to read and interpret data using SQL, Clarity, Caboodle, and/or SlicerDicer.

• Excellent communication skills, with the ability to translate business and regulatory requirements into system designs and produce clear documentation and presentations.

Preferred / Nice to Have:

• Active Epic Tapestry Utilization Management Certification

• Additional Epic certifications (Tapestry Benefits/Contracts, Claims, Care Management, Member Enrollment, Security).

• Experience with EDI X12 278/275, payer integration patterns, and attachment management.

• Familiarity with clinical criteria tools such as InterQual and MCG.

• Experience supporting provider portals, delegated entities, or delegated risk models.

• Clinical background (e.g., RN) or significant experience partnering with clinical reviewers and Medical Directors.

• Prior experience with health plans, payer organizations, delegated risk provider groups, or large IDNs with plan operations.