Epic Tapestry Utilization Management

About the role

Chartis is actively seeking a specialized Epic Tapestry Utilization Management (UM) Analyst to join a critical contractual engagement. In this capacity, you will own the complete lifecycle management of the Epic Tapestry UM module, acting as the central configuration and optimization authority. Your daily work will involve designing, building, and refining complex prior authorization and referral workflows to meet stringent regulatory standards. You will serve as the definitive subject matter expert, bridging the gap between intricate operational policies and precise system functionality. This role demands close collaboration with a wide array of stakeholders, from clinical reviewers to IT teams, to ensure seamless execution. Ultimately, you will be responsible for reducing administrative friction and elevating the experience for both healthcare members and provider networks. The position is mission-critical for enabling efficient and compliant utilization management operations across the organization.

Key facts

What you'll do

• Architecting and configuring the core modules within the Epic Tapestry utilization management framework to align with strategic objectives.
• Developing intricate prior authorization workflows and logic that accurately translate complex clinical policies into executable system rules.
• Building and managing sophisticated routing rules and decision trees to govern the flow of referral and authorization requests.
• Establishing and maintaining work queues, timing thresholds, and auto-status logic to optimize case progression and meet turnaround mandates.
• Partnering with utilization management and care management leadership to dissect business requirements and model future-state processes.
• Collaborating extensively with clinical reviewers, provider relations specialists, and case management teams to refine and enhance end-to-end operational workflows.
• Configuring and managing Tapestry Care Link integrations to facilitate seamless interactions with external providers and network partners.
• Managing provider portal interactions, defining granular security roles, and facilitating appropriate external user access configurations.
• Ensuring every configured workflow is meticulously aligned with specific benefit plan designs, provider network structures, and claims adjudication processes.
• Actively contributing in design sessions, leading workflow validation exercises, and formulating actionable solution recommendations based on analysis.
• Developing detailed functional specifications and comprehensive configuration documentation to support implementation and knowledge transfer.
• Conducting rigorous system testing, including unit, integration, regression, and user acceptance testing (UAT) to ensure quality and compliance.
• Troubleshooting complex application issues, performing deep root cause analysis, and coordinating expedited resolutions with technical and clinical teams.
• Providing dedicated support for Epic system upgrades, managing enhancements, driving ongoing optimization initiatives, and handling production support escalations.
• Contributing to go-live planning, participating in command center operations, and supporting post-production stabilization activities.
• Developing and defining detailed reporting requirements while working closely with analytics teams to support key operational performance indicators.
• Ensuring all workflows and configurations meet or exceed compliance standards for CMS, NCQA, URAC, HIPAA, and all applicable state-specific turnaround time regulations.

Requirements

• Demonstrated hands-on experience configuring Epic Tapestry utilization management tools and functionalities.
• Thorough and proven understanding of prior authorization logic, referral processes, and service authorization mechanisms within a healthcare context.
• Extensive knowledge of workflow automation principles and event processing methodologies as applied to utilization management.
• A demonstrated, strong commitment to ensuring strict adherence to CMS, NCQA, URAC, and HIPAA timing standards and regulatory requirements.
• The ability to communicate effectively and inclusively with both highly technical stakeholders and clinical professionals is an essential job function.
• Clear understanding of benefit plan designs, provider networks, care management strategies, and their interplay with claims adjudication processes.
• Proven capability to analyze complex operational requirements and translate them into precise system configurations and functional specifications.
• Strong attention to detail and robust problem-solving skills necessary for managing multiple priorities in a deadline-driven environment.

Nice to have

• Direct, hands-on experience with Care Link workflows specifically for external providers and delegated network entities is a preferred qualification.
• Proficiency and advanced knowledge in related Epic modules or healthcare technology platforms that support utilization management objectives.
• Prior experience working within highly regulated compliance environments where documentation and audit readiness are paramount.
• Experience leading or contributing to process improvement initiatives that resulted in measurable efficiency gains in prior authorization or referral cycle times.
• Familiarity with specific state-level regulatory nuances impacting utilization management and telehealth services.

Practical notes

• Hours: Full-time equivalent commitment required, typically aligned with standard business hours for collaboration, though flexible scheduling may apply based on project needs.
• Travel: Not applicable or required for this remote-based position.
• Visa: Sponsorship information is not available at this time for this specific contractual role.
• Deadlines: The initial engagement is defined for a duration of 3 to 5 months, with performance and project needs potentially influencing extension considerations.

About Chartis: Redefining Healthcare Strategy

Chartis stands at the forefront of transforming the United States healthcare landscape. The industry confronts persistent and deep-seated challenges that demand more than incremental change. As a collective force of over 1,450 dedicated professionals, we partner with more than 1,900 organizations each year. Our mission is to design and activate strategies, operating models, and enterprise structures that make healthcare more affordable, accessible, safe, and human. We serve a diverse ecosystem, including providers, payers, technology innovators, retail companies, and investors, empowering them to create and embrace solutions that deliver tangible, material improvements to the system. Our commitment is embodied in our family of brands-Chartis, Jarrard, Greeley, and HealthScape Advisors-each with a singular, unwavering focus on healthcare transformation, regardless of scale. This is the foundation upon which we invite you to believe in better. Chartis maintains a national footprint with offices in Boston, Chicago, New York, Washington D.C., and Nashville. We embrace the flexibility of remote work to support our collaborative culture.