UM Analyst

🕒 March 18

Apply Now

Find Similar Remote Jobs

Receive Emails For Remote Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

Vytwo Technologies Inc

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 2003

🤝 B2B

🏢 Enterprise

🎯 Recruiter

B2B • Enterprise • Recruitment

<Vytwo Technologies Inc. > Vytwo Technologies is a globally recognized enterprise applications integrator and IT services firm based in Minneapolis, MN. The company provides IT consulting, system integration, custom application and product development, ERP and cloud-related solutions, re-engineering, maintenance, and outsourcing services for mid-to-large organizations. It also offers product support, printing outsourcing and staffing services, focusing on improving clients' sales efficiency and accelerating time-to-market through disciplined delivery and process-driven execution.

📋 Description

• Configure and optimize Tapestry UM workflows for prior authorizations (e.g., medical, behavioral health, pharmacy-to-medical crossovers) and referrals (in- and out-of-network), including routing rules, WQs, templates, smart text, decision trees, and notification logic. • Leverage Tapestry Care Link for external provider access—set up roles, security, workflows, documentation tools, and training materials to support referring providers, delegated entities, and partners. • Align UM workflows with benefit plan configuration, provider network tiering, care management touchpoints, and claims adjudication.

🎯 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.