UM Analyst

🕒 March 18

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Vytwo Technologies Inc

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 2003

💼 Consulting

📦 Logistics

🎯 Recruiter

Consulting • Logistics • 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.