Utilization Management Business Analyst II

DE&I Statement

At Pri Med, your uniqueness is valued, celebrated, encouraged, supported, and embraced. Whatever your relationship with Hill Physicians, we welcome ALL that you are. We value and respect your race, ethnicity, gender identity, sexual orientation, age, religion, disabilities, experiences, perspectives, and other attributes. Our celebration of diversity and foundation of inclusion allows us to leverage our differences and capitalize on our similarities to better serve our communities.

The Utilization Management Business Analyst will serve as a critical link between our Authorizations operations and IT teams, focusing on optimizing the utilization management workflows within the Epic system. This role will analyze business processes, design solutions, and support the implementation and maintenance of the Epic Utilization Management module to enhance operational efficiencies and ensure compliance with regulatory requirements. The position reports to the Manager, Authorizations Business Product Management.

• Provide first‑tier support for Utilization Management and related workflows with teams such as Compliance, Contracting, Concurrent Review, Enrollment, Claims, Customer Services, Regional Services, and Provider Data. Route and track complex issues and system configuration requests to IT and other relevant teams.
• Conduct analysis of identified issues and intake enhancement requests, recommending potential system solutions.
• Gather business requirements from stakeholders, obtain leadership approval, and design system workflows as needed.
• Serve as point person for all testing activities related to system updates – operational changes, enhancements, reports, and projects.
• Generate and distribute key operational reports using Epic Reporting Workbench (RWB) for UM leadership and compliance audits. Perform data analysis to present summaries and recommendations.
• Collaborate with the Informatics team to develop complex reports and dashboards.
• Distribute announcements for system updates and participate in system demonstrations and training content creation.
• Maintain and monitor adjudication rules, working with Business and IT teams to improve auto‑approval rates in Tapestry.
• Maintain procedure codes and code levels, collaborating with Business and IT teams.
• Analyze code usage, presenting recommendations for monitoring outliers identified by Informatics.
• Own integrated UM workflows in Tapestry, collaborating with Business and IT teams to optimize workflow and work‑queue routing and maintenance.
• Participate in Epic IT projects on behalf of the department, mitigating risks to Utilization Management KPIs such as Electronic Adjudication rate, Turnaround Time compliance, and pending work‑queue volumes.
• Participate in Data Governance stewardship meetings and initiatives, representing the Utilization Management team to identify and solve data‑needs.

• Certification in Epic Tapestry UM/CM or a related module.
• Minimum 3 years of experience with Epic Reporting Workbench.
• Minimum 3 years of experience as a Business/Systems Analyst or a similar position.
• Demonstrated ability to elicit, analyze, and communicate business requirements effectively.
• Strong interpersonal skills, with the ability and willingness to build positive relationships with internal and external teams.
• Excellent communication, critical thinking, and problem‑solving skills.
• Ability to exercise good judgment, prioritize multiple tasks, and work independently with initiative and pro‑activity.
• Proficiency with Microsoft Office suite:
  Excel, Outlook, Word, Teams, and PowerPoint.

• Salary range: $100,000 - $127,000 per year.
• Hill Physicians is an Equal Opportunity Employer.