Job Description
Note: The job is a remote job and is open to candidates in USA. UnitedHealthcare is simplifying the health care experience and creating healthier communities. The Occupational Therapy Clinical Consultant provides expert clinical guidance to support utilization management and care management, focusing on promoting member independence and ensuring appropriate resource utilization.
- Responsibilities
- 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
- Skills
- 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
- Benefits
- 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.)
- Company Overview
- UnitedHealthcare helps people live healthier lives by simplifying the health care experience. It was founded in 1977, and is headquartered in Minnetonka, Minnesota, USA, with a workforce of 10001+ employees. Its website is http://www.uhc.com.
- Company H1B Sponsorship
- UnitedHealthcare has a track record of offering H1B sponsorships, with 48 in 2025, 26 in 2024, 45 in 2023, 61 in 2022, 60 in 2021, 68 in 2020. Please note that this does not guarantee sponsorship for this specific role.
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