Job Closed

This listing is no longer active.

Vytwo Technologies Inc logo
Vytwo Technologies Inc

Delivering Talent. Driving Results

Tapestry UM Analyst

Business AnalystBusiness AnalystOtherRemoteTeam 201-500Since 2003H1B No SponsorCompany SiteLinkedIn

Location

United States

Posted

108 days ago

Salary

0

Job Description

Tapestry UM Analyst

Vytwo Technologies Inc

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description We are seeking an experienced Epic Tapestry Utilization Management Analyst to design, build, optimize, and support UM processes focused on authorizations and referrals. The ideal candidate is Epic Tapestry UM Certified, has practical experience with Tapestry Care Link, and is adept at translating payer and network operations needs into scalable Epic solutions. - Partner with UM leadership, clinical reviewers, provider relations, care management, claims, and integration teams to enable compliant, efficient, and transparent UM determinations. - Reduce administrative burden and improve member and provider experience. Qualifications - 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. Requirements - 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 Description

Job Requirements

  • 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.
  • 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.

Related Categories

Related Job Pages

More Business Analyst Jobs

HJ Staffing logo

Business Analyst, Quality and Business Performance

HJ Staffing

Providing the highest level of professional personnel solutions and placing top talent to all organizations.

Business Analyst108 days ago
OtherRemoteTeam 11-50Since 2016H1B No Sponsor

• Design and conduct deep-dive analysis across multiple datasets • Build and maintain detailed workflows, data models, and use cases • Facilitate workshops to prioritize business needs and deliver compelling presentations • Assist in the design and implementation of healthcare IT solutions • Evaluate the long-term effectiveness of implemented solutions

Florida
Job Closed
OtherRemoteTeam 201-500Since 1996H1B No Sponsor

• Review user stories in backlog; gain a solid understanding of the changes needed. • Collaborate with Product Owners to understand user stories and updates needed. • Document acceptance criteria for user stories and bug tickets. • Help Developers understand the user stories and acceptance criteria, and lead discussions of new functionality. • Test user stories and ensure that testing is appropriately documented, with evidence recorded. • Serve as scrum master/ lead daily scrums. • Develop an agenda for backlog grooming session; get concurrence with Product Owners. • Lead backlog grooming sessions with Product Owners. • Lead demo day and introduce stories to the Product Owners • Train stakeholders on new functionality • Document business processes and changes • Update requirements documentation • Update user manuals

Virginia
$100K - $120K / year
Job Closed

Senior Business Analyst

Upstream Rehabilitation

Upstream Rehabilitation is the largest pure-play provider of outpatient physical therapy in the United States, with a mission to inspire and empower people to a

Business Analyst108 days ago

• Lead end‑to‑end requirements analysis for healthcare transformation initiatives, including elicitation, documentation, validation, and change control. • Conduct current‑state assessments and design future‑state workflows that enhance operational efficiency and support system improvements. • Develop clear, complete, and testable requirements, including business, functional, non‑functional, data, integration, and user experience (UX) specifications. • Partner with Quality Assurance teams to support test plan development, test script creation, and requirements traceability throughout the project lifecycle. • Participate in User Acceptance Testing (UAT) and assist with go‑live preparation, deployment readiness, and post‑implementation stabilization. • Create high‑quality documentation, such as process flows, user stories, visual prototypes, and knowledge‑transfer materials. • Engage and collaborate with stakeholders across clinical, operational, and technical teams to ensure alignment and successful execution of project goals. • Other projects and duties as assigned.

Alabama
$99.8K - $114K / year
Job Closed
Keywords Studios logo

IT Business Partner Manager - 12 month contract

Keywords Studios

International technical and creative services provider to the global video games industry and beyond.

Business Analyst109 days ago
ContractRemoteTeam 10,001+Since 1998H1B No Sponsor

Role Description Nous cherchons un(e) gestionnaire des partenaires d’affaires TI faisant preuve d’un bon sens de l’organisation et de proactivité qui deviendra la liaison TI dédiée de notre branche d’activité Médias et divertissement. Ce rôle sert de lien entre nos initiatives TI centrales et treize de nos studios créatifs répartis sur toute la planète. Vous devrez gérer l’intégration sans accroc de ces studios à ces plateformes technologiques stratégiques et serez le principal point de contact pour les escalades liées aux TI. Le ou la candidat(e) idéal(e) maîtrise la gestion des changements et les communications avec les parties prenantes, et est capable de tenir compte des besoins techniques et culturels uniques des studios créatifs tout en prenant en charge les standards TI d'entreprise. Responsabilités clés - Escalade et soutien pour les studios – Servir de ressource d’escalade principale pour les problèmes liés aux TI et les demandes de services pour treize studios de médias et divertissements, afin que les problèmes soient résolus en temps opportun et que les informations soient communiquées efficacement en partenariat avec nos équipes de livraison de services globales. - Intégration stratégique – Diriger et gérer la transition des studios vers des initiatives TI d'entreprise clés, incluant : - Google Workplace – Encourager l’adoption et la migration vers Google Workplace et l’utilisation appropriée des outils IA à des fins d’optimisation. - ServiceNow – Superviser l’adoption de ServiceNow pour simplifier la gestion des services TI et prioriser l’adaptation du catalogue afin d’encourager l’automatisation. - Gestion des actifs matériels (HAM) – Gérer le déploiement de notre nouvel appel d’offres pour le matériel et implémenter des protocoles standardisés de gestion du matériel. - Gestion des actifs logiciels (SAM) – Diriger les efforts de consolidation et d’optimisation des logiciels afin d’améliorer l’efficacité et de réduire les coûts. - Progiciel de gestion intégré et Workday – Guider les studios tout au long de l’intégration et de l’adoption de nos nouveaux progiciels de gestions intégrés et des plateformes Workday pour travailleurs occasionnels. - Gestion des changements – Développer et exécuter des plans de transition détaillés, créer de la documentation et organiser des formations afin de faciliter l’adoption des nouveaux systèmes et processus tout en perturbant le moins possible les opérations des studios. - Engagement des parties prenantes – Bâtir des relations solides basées sur la collaboration avec la direction du studio et des membres clés du personnel afin de comprendre leurs besoins commerciaux et que les initiatives des TI apportent de la valeur. Qualifications - Baccalauréat en technologies de l’information, en gestion d’entreprise ou dans un domaine connexe, ou une période d’expérience professionnelle équivalente. - Au moins 5 ans d’expérience en gestion de projets TI, en transition de services ou dans un rôle similaire, préférablement au sein d’une organisation d’échelle mondiale. - Expérience prouvée en gestion de projets comportant l’adoption à grande échelle de nouvelles technologies (par exemple, SharePoint, ServiceNow, ERP). - Compétences exceptionnelles en matière de communication, de relations interpersonnelles et de gestion des parties prenantes. - Compréhension solide des principes et des meilleures pratiques d’ITIL/ITSM. - Toute expérience de travail au sein d’industries créatives, telles que les médias et divertissements ou les jeux vidéos, est un atout. - Capacité à gérer de nombreux projets simultanément au sein d’un environnement au rythme soutenu. Benefits - Indemnisation compétitive à la mesure des compétences et de l'expérience apportées. - Bénéfices conséquents. - Satisfaction au travail élevée. - Environnement de travail plaisant. Company Description Keywords International se donne pour mission de suivre une politique strict d'égalité des chances. Nous nous efforçons ainsi de créer un environnement de travail offrant des opportunités identiques à l'ensemble de nos employés actuels et potentiels. Pour des raisons de lisibilité, le masculin pourrait être employé dans ce document mais il s'adresse aux candidats sans distinction de genre. Note à l’intention des agences de recrutement : Veuillez noter que Keywords Studios ne prendra pas en considération les CV non sollicités ou toute forme de contact émanant de tiers non autorisés, y compris les agences de recrutement ou de placement, à moins qu’un accord préexistant et valide n’ait été conclu. Keywords Studios ne remboursera aucuns frais encourus par des tiers non autorisés.

Worldwide
Job Closed