Solutions Manager (EMR Workflow Design)

Humata Health is seeking a Solutions Manager with deep Epic workflow expertise to join their Customer Success team. The role involves designing optimized EMR configurations and leading a team to ensure effective workflow implementation for health system customers.

Responsibilities:

• Design end-to-end prior authorization workflows within Epic that integrate with Humata's automation platform, including:
• Referral-based workflows (278R transaction triggers from Orders, Referrals, or Scheduled Appointments)
• BPA (Best Practice Advisory) / CDS configurations for real-time authorization checks
• In Basket routing for authorization status updates and pended requests
• Integration with Epic Cadence (scheduling) and Grand Central (registration/ADT) for coverage verification
• Own the workflow configuration strategy, determining:
• Which clinical events should trigger authorization requests
• What clinical data elements need to be aggregated and mapped
• How customers should approach workflow segmentation in workqueues
• How to route tasks between schedulers, authorization specialists, and providers
• Where Humata's automation fits into existing Epic workflows vs. where Epic-native tools should be used
• Design clinical data aggregation strategies to support medical necessity determinations:
• Problem List, Medications, Lab Results, Imaging Reports
• Procedure and Diagnosis code mapping from encounter documentation
• Progress Notes and clinical summary extraction
• Custom SmartData Elements for payer-specific requirements
• Serve as the primary workflow SME for customer IT, Epic analysts, and clinical operations teams during implementations and expansions
• Lead workflow discovery sessions with health system stakeholders to:
• Map current-state authorization processes and pain points
• Identify automation opportunities and workflow optimization strategies
• Define future-state workflows that balance automation with clinical review requirements
• Engage customer stakeholders on the broader processes that come before and after the prior authorization workflow:
• Identify risks and propose optimizations that will increase the success and value of an implementation
• Collaborate with customers on design of future state process improvements, diagramming approaches and supporting change management efforts
• Provide Epic-specific guidance on:
• Which Epic modules/tools and people to leverage (Referrals, Orders, Prelude, Cadence, etc.)
• Configuration options for authorization workflows (Orders vs. Referral-initiated)
• Build vs. buy decisions for Epic-native functionality
• Upgrade planning and compatibility with Humata integrations
• Translate complex payer authorization requirements into actionable Epic configuration specifications
• Build and maintain a library of reference workflow designs for common use cases:
• Outpatient therapy series authorizations (PT/OT/ST)
• High-cost imaging pre-authorizations (MRI, CT, PET)
• Specialty pharmacy authorizations
• Delegated entity workflows (Carelon, Evicore, Prime Therapeutics)
• Create Epic-specific implementation guides including:
• Build specifications
• Workqueue best practices
• BPA configuration examples
• Staff training materials for authorization workflows
• Document workflow optimization patterns that reduce administrative burden while maintaining compliance
• Partner with Product Management to ensure Humata's platform capabilities align with real-world Epic workflow constraints and opportunities
• Provide feedback on product roadmap priorities based on customer workflow needs
• Identify gaps in current automation capabilities that require new Epic integration points
• Collaborate with Solutions Engineers to ensure workflow designs are technically feasible given integration architecture
• You will lead a team responsible for Epic workflow design and directly manage Solutions Engineers and Workflow Consultants
• Coach team members on Epic design best practice and consulting skills
• Provide performance feedback, coaching and career development
• Hire and onboard new team members as the team scales

Requirements:

• 5+ years of hands-on Epic experience, with at least 3 years in one or more of the following areas: Epic implementation/optimization consulting (preferably Revenue Cycle or Ambulatory), Epic application analyst role (Referrals, Orders, Cadence, Prelude, or Grand Central), Epic workflow development and configuration
• Direct experience with Epic prior authorization workflows, including: Understanding of how 278 transactions map to Epic data elements, Configuration of authorization request triggers and routing, Integration between Epic and payer portals or clearinghouses, Staff workflows for authorization submission, tracking, and follow-up
• Deep knowledge of Epic's technical architecture for workflow design: Epic workflows and configuration (Chronicles backend logic, rules, and triggers), Clinical data capture tools, BPA configuration and logic, In Basket message routing and task management, Report writing for workflow monitoring (Clarity/Caboodle)
• Strong understanding of healthcare operations: Revenue cycle workflows (scheduling, registration, authorization, billing), Utilization management and medical necessity requirements, Payer-provider interactions and common authorization pain points, HIPAA compliance in workflow design
• Leadership and management experience: Prior experience leading or mentoring analysts, consultants or technical team members, Comfortable serving as an escalation point and advisor to team members to unblock challenges, Can balance strategic planning, hands-on design and people management in a hybrid role
• Epic certification(s) in relevant modules (Referrals, Resolute HB, Cadence, Prelude, or Orders)
• Former Epic employee (especially from Revenue Cycle, Resolute HB, Referrals, or Cadence teams), with no remaining non-competition constraints
• Experience working with delegated review entities (Carelon/Evicore/Prime) and their Epic integrations
• Exposure to RPA tools or automation platforms
• Experience with SMART on FHIR or other interoperability frameworks
• Familiarity with series authorization workflows for therapy services (PT/OT/ST)
• Experience training or mentoring Epic analysts or clinical staff
• Understanding of payer portal navigation and manual authorization processes