Epic Tapestry Utilization Management Analyst
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Job Location:
Eden Prairie, MN - USA
Monthly Salary:
Not Disclosed
Posted on:
1 hour ago
Vacancies:
1 Vacancy
Job Summary
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.
- 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.
