Epic Tapestry Utilization Management Analyst

This is 3 months contract with possibility of extention. You can work part time as well (20 hours/week)

Position Summary

We are seeking an experienced Epic Tapestry Utilization Management Analyst to support the design, configuration, build, testing, and implementation of Appeals and Grievances workflows within a healthcare insurance environment.

The consultant will work closely with utilization management, appeals and grievances operations, compliance, business, and technical stakeholders to translate operational requirements into effective Epic Tapestry workflows.

An active Epic Tapestry Utilization Management certification is mandatory for this position.

Primary Responsibilities

• Design, configure, and build Appeals and Grievances functionality within Epic Tapestry Utilization Management.
• Gather and document business, operational, and system requirements from health-plan stakeholders.
• Evaluate existing Appeals and Grievances processes and translate approved requirements into Epic system configurations.
• Configure workflows supporting case intake, assignment, routing, status tracking, review activities, escalations, decision documentation, and case closure.
• Configure or support workqueues, rules, workflows, and other application components associated with Appeals and Grievances processing.
• Support the tracking of due dates, turnaround times, priorities, and escalated cases based on the client’s approved operational requirements.
• Coordinate with letter, correspondence, reporting, integration, and operational teams when Appeals and Grievances workflows depend on related functionality.
• Perform application build validation and unit testing.
• Develop test scenarios and support system integration testing, user acceptance testing, and defect resolution.
• Troubleshoot workflow and configuration issues and recommend appropriate solutions.
• Maintain clear documentation of system configurations, workflow decisions, test results, and outstanding issues.
• Support implementation readiness, deployment, go-live, and post-production stabilization activities, as required.
• Provide knowledge transfer and guidance to client analysts, operational users, and support teams.
• Work independently while communicating progress, risks, dependencies, and decisions to project leadership.

Required Qualifications

• Active Epic Tapestry Utilization Management certification.
• Hands-on experience configuring or building Appeals and Grievances functionality within Epic Tapestry.
• Experience working in a healthcare payer, health-plan, managed-care, or healthcare insurance environment.
• Understanding of utilization management and Appeals and Grievances operational workflows.
• Experience gathering requirements and translating business processes into Epic application configurations.
• Experience with application build, testing, defect resolution, and implementation support.
• Ability to analyze complex workflows and identify configuration gaps or dependencies.
• Ability to work independently and deliver assigned build activities within established timelines.
• Strong documentation, communication, and stakeholder-management skills.

Preferred Qualifications

• Experience supporting Medicare, Medicaid, commercial, or other managed-care lines of business.
• Familiarity with regulatory and operational requirements affecting health-plan Appeals and Grievances processes.
• Experience with organization determinations, coverage determinations, reconsiderations, prior authorizations, or related utilization management processes.
• Experience configuring workqueues, routing rules, case statuses, turnaround-time tracking, escalations, and correspondence-related workflows.
• Experience supporting Epic Tapestry implementation, optimization, upgrade, or remediation projects.
• Experience with Epic Payer Platform, shared-instance environments, reporting, integrations, or related Tapestry applications.
• Experience supporting user acceptance testing, go-live activities, production stabilization, and knowledge transfer.

Certification Requirement

Candidates must hold a current and active Epic Tapestry Utilization Management certification. Certification status will be verified during the screening process.