Top 5 Clinical contracts analyst (remote) Jobs in Columbus

Epic Tapestry UM Analyst
Vytwo —United States
- $50 an hour
- Full-time
- Remote
- 5 years
- HIPAA
- Mid-level
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Epic Tapestry UM Analyst
Vytwo —United States
Solid understanding of payer operations and UM regulations (e.g., CMS timelines, state TATs, HIPAA, NCQA), including denial and appeal pathways.
$50 an hour
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Epic Tapestry UM Analyst

Vytwo
United States

Quick Apply

Job Details

Full-time
$50 an hour

Qualifications

Overseeing health insurance pre-certification
Requirements design
Managed care organization experience
CMS
Software implementation
HIPAA
SQL
System design for system development
Technical solutions implementation
Key Performance Indicators
CMS regulatory compliance
Healthcare referral management
Documentation tools
Release management
Utilization management
User acceptance testing
Resource utilization in healthcare
Presentation preparation
Health insurance referral requirements
Epic Certification
Unit testing
Epic
Business requirements
Implementing IT solutions
Design (software development lifecycle)
Analytics

Full Job Description

^Remote Work
**Must be authorized to work in USA.

Job Description:
We are seeking an experienced Epic Tapestry Utilization Management Analyst to design, build, optimize, and support UM processes focused on authorizations and referrals.
The ideal candidate is Epic Tapestry UM Certified, has practical experience with Tapestry Care Link, and is adept at translating payer and network operations needs into scalable Epic solutions.
You will partner with UM leadership, clinical reviewers, provider relations, care management, claims, and integration teams to enable compliant, efficient, and transparent UM determinations that reduce administrative burden and improve member and provider experience.

Preferred:

Additional Epic credentials (e.g., Tapestry Benefits/Contracts, Claims, Care Management, Member Enrollment, Security).
Experience with EDI X12 278/275 workflows and payer integration patterns.
Familiarity with industry clinical criteria tools (InterQual, MCG) and attachment management.
Exposure to provider portal strategies and delegated entity oversight.
Clinical background (e.g., RN) or strong experience partnering with clinical reviewers and Medical Directors.
Prior experience in payers/health plans, delegated risk provider groups, or large IDNs with plan operations.

Key Responsibilities
Solution Design & Build

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.

Required skills:

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.

This is a remote position.

Quick Apply

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