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

• 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

• 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

• 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.