What are the responsibilities and job description for the Occupational Therapy Clinical Consultant- Remote in Kansas position at UnitedHealthcare?
At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities, and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable, and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.
The Occupational Therapy Clinical Consultant provides expert functional assessment and independence-focused clinical guidance to support utilization management, care management, and medical directors in evaluating HCBS, DME, and related services. This role applies occupational therapy principles to promote member independence, ensure appropriate resource utilization, and delay or prevent reliance on personal care services or institutional care.
The role is consultative and non-direct care, enhancing clinical decision-making, consistency, and defensibility across functional determinations.
If you are located within the state of Kansas, you will have the flexibility to work remotely* as you take on some tough challenges.
Primary Responsibilities
Clinical Consultation & Decision Support
Required Qualifications
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
#RPO #GREEN
The Occupational Therapy Clinical Consultant provides expert functional assessment and independence-focused clinical guidance to support utilization management, care management, and medical directors in evaluating HCBS, DME, and related services. This role applies occupational therapy principles to promote member independence, ensure appropriate resource utilization, and delay or prevent reliance on personal care services or institutional care.
The role is consultative and non-direct care, enhancing clinical decision-making, consistency, and defensibility across functional determinations.
If you are located within the state of Kansas, you will have the flexibility to work remotely* as you take on some tough challenges.
Primary Responsibilities
Clinical Consultation & Decision Support
- Serve as a subject matter expert for functional performance, ADLs/IADLs, and environmental adaptations.
- Provide consultation to nurses, social workers, and medical directors during:
- HCBS eligibility and level-of-care reviews
- Personal care hour determinations and reauthorizations
- DME, assistive technology, and home modification requests
- Translate functional limitations into appropriate, independence-promoting interventions.
- Guide clinicians in differentiating:
- Physical or cognitive impairments vs environmental barriers
- Task difficulty vs true dependency
- Supervision needs vs hands-on assistance
- Recommend stepwise approaches prioritizing:
- Adaptive equipment
- Environmental modification
- Skill-building or task simplification
- Personal care services when clinically necessary
- Review and advise on DME requests for appropriateness, effectiveness, and cost efficiency.
- Identify alternatives that may reduce or delay reliance on personal care services.
- Partner with vendor management and policy teams to align equipment options with functional goals.
- Contribute OT expertise to:
- Medical necessity criteria for HCBS and DME
- Appeals and peer-to-peer clinical reviews
- Standardized functional assessment tools and workflows
- Support quality initiatives focused on aging in place and disability independence.
- Educate internal clinicians on:
- Functional, task-based decision-making
- Independence-promoting strategies
- Appropriate use of adaptive equipment
- Develop tools such as:
- Functional decision trees
- DME substitution guides
- Case exemplary and training materials
- Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
- Medical Plan options along with participation in a Health Spending Account or a Health Saving account
- Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
- 401(k) Savings Plan, Employee Stock Purchase Plan
- Education Reimbursement
- Employee Discounts
- Employee Assistance Program
- Employee Referral Bonus Program
- Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)
- More information can be downloaded at: http://uhg.hr/uhgbenefits
Required Qualifications
- Active Occupational Therapist license (OTR/L) in the state of Kansas
- 5 years of clinical OT experience, including: (Home health, community-based care, rehab, or LTSS populations)
- 2 years of experience in ADL/IADL assessment, DME and adaptive equipment, and Aging and disability-related functional decline
- 2 years of experience working collaboratively with interdisciplinary teams
- Experience in managed care, utilization management, or care management
- Experience contributing to policy, quality, or program development
- Familiarity with HCBS programs, LTSS, Medicaid/Medicare populations
- Strong written and verbal communication skills for clinical documentation and appeals
- All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
#RPO #GREEN
Salary : $29 - $52