Utilization Review Clinician - ABA

We need to output HTML fragment with sections: h3 headings for sections present. Must not repeat job title. Must include only sections with real content. Must not include boilerplate like EEO etc. Must preserve all substantive info. We need to parse the posting. Content: Position Purpose: Performs reviews of member's care and health status of Applied Behavioral Analysis (ABA) services provided to determine medical appropriateness. Monitors clinical effectiveness and efficiency of member's care in accordance with ABA guidelines. Key Details: Must reside in PST, MST, or CST time zone. Evaluates member’s care and health status before, during, and after provision of Applied Behavioral Analysis (ABA) services to ensure level of care and services are medically appropriate related to behavioral health (BH) and/or autism spectrum disorder needs and clinical standards Performs prior authorization reviews related to BH to determine medical appropriateness in accordance with ABA regulatory guidelines and criteria Analyzes BH member data to improve quality and appropriate utilization of services Interacts with BH healthcare providers as appropriate to discuss level of care and/or services provided to members receiving Applied Behavior Analysis Services Provides education to members and their families regarding ABA and BH utilization process Provides feedback to leadership on opportunities to improve care services through process improvement and the development of new processes and/or policies Performs other duties as assigned. Complies with all policies and standards. Education/Experience: Requires Graduate of an Accredited School of Nursing or Bachelor's degree and 2-4 years of related experience. For Enterprise Population Health 2+ years providing ABA services as a BCBA License to practice independently, and/or have obtained the state required licensure as outlined by the applicable state (BCBA) required. Master’s degree for behavioral health clinicians required. Behavioral health clinical knowledge and ability to review and/or assess ABA Treatment Plans required. Knowledge of ABA services and BH utilization review process required. Experience working with providers and healthcare teams to review care services related to Applied Behavior Analysis Services preferred. License/Certification LCSW- License Clinical Social Worker required or LMHC-Licensed Mental Health Counselor required or LPC-Licensed Professional Counselor required or Licensed Marital and Family Therapist (LMFT) required or Licensed Mental Health Professional (LMHP) required or Board Certified Behavior Analyst (BCBA) required RN - Registered Nurse - State Licensure and/or Compact State Licensure RN - Registered Nurse- State Licensure and/or Compact State Licensure with BCBA required or Independent licensure with ABA experience and BCBA preferred. preferred Licensed Behavior Analyst (LBA) where required by state required Pay Range: $27.02 - $48.55 per hour At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday. Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. (Then EEO etc which we must remove.) We need sections: About the role? The posting has "Position Purpose" and "Key Details". Could map to "About the role" maybe. But we must use headings exactly: About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. We need to decide which sections have content. We have: - Position Purpose + Key Details: could be "About the role" (description of role). Or we could split into "Responsibilities" (the duties). The posting includes many duty statements: evaluating care, prior auth, analyzing data, interacting with providers, providing education, feedback to leadership, other duties, compliance. Those are responsibilities. - Education/Experience + License/Certification: could be "Requirements" or "Qualifications". The posting includes education/experience requirements and license/certification. Could be "Qualifications". We'll need to decide. - Pay Range: $27.02 - $48.55 per hour => Pay section. - Benefits: description of benefits package => Benefits section. - Schedule: not explicitly given; only mention flexible approach to work with remote, hybrid, field or office work schedules. That's schedule info. Could be Schedule section. We must not create sections with filler like "not specified". We have schedule info: "flexible approach to work with remote, hybrid, field or office work schedules." That's specific enough. We must not repeat job title. Must not include Job ID etc. We must remove boilerplate: EEO etc. Also remove "At Centene, we connect people..."? That's marketing but maybe considered boilerplate? It's not EEO but it's generic company description. The instruction: remove cookie/navigation/legal/EEO/equal-opportunity/scam-warning boilerplate, duplicated lines, and application instructions. The Centene marketing paragraph might be considered boilerplate? It's not legal/EEO, but it's generic fluff. Might be considered boilerplate? The instruction says remove cookie/navigation/legal/EEO/equal-opportunity/scam-warning boilerplate, duplicated lines, and application instructions. It doesn't explicitly say remove marketing fluff. However, we should preserve ALL substantive information; do NOT invent or summarize away detail. The marketing paragraph is not substantive to the job? It's about company mission. Might be considered not essential but could be kept? The instruction says preserve ALL substantive information; do NOT invent or summarize away detail. The marketing paragraph is not a requirement or duty; it's fluff. Might be considered not substantive. Safer to remove it? But it's not explicitly listed as boilerplate to remove. However, many similar tasks treat such generic company description as boilerplate. I'd lean to remove it to keep focus on job details. But we need to be careful: The instruction says "remove cookie/navigation/legal/EEO/equal-opportunity/scam-warning boilerplate, duplicated lines, and application instructions." It does not say remove marketing fluff. So we should keep it unless it's considered duplicated lines? Not duplicated. So we should keep it? However, the instruction also says "Prefer a few substantive sections over many thin ones." The marketing paragraph could go under "About the role" maybe as a brief description. But we already have position purpose. Could combine. Better to include a short paragraph under "About the role" that includes position purpose and key details. The marketing fluff could be omitted as not substantive. I'd omit. Now we need to format. Sections:

About the role

Performs reviews of member's care and health status of Applied Behavioral Analysis (ABA) services provided to determine medical appropriateness. Monitors clinical effectiveness and efficiency of member's care in accordance with ABA guidelines. Must reside in PST, MST, or CST time zone. Evaluates member’s care and health status before, during, and after provision of Applied Behavioral Analysis (ABA) services to ensure level of care and services are medically appropriate related to behavioral health (BH) and/or autism spectrum disorder needs and clinical standards. Performs prior authorization reviews related to BH to determine medical appropriateness in accordance with ABA regulatory guidelines and criteria. Analyzes BH member data to improve quality and appropriate utilization of services. Interacts with BH healthcare providers as appropriate to discuss level of care and/or services provided to members receiving Applied Behavior Analysis Services. Provides education to members and their families regarding ABA and BH utilization process. Provides feedback to leadership on opportunities to improve care services through process improvement and the development of new processes and/or policies. Performs other duties as assigned. Complies with all policies and standards.

That covers purpose and key details. Next responsibilities: Actually the above already includes duties. Could treat as Responsibilities. But we already used About the role. Maybe we should split: About the role = brief summary; Responsibilities = list of duties. However we have many duty sentences; we could put them under Responsibilities as a

• . Let's do that. Thus:

  About the role

  Position purpose: Performs reviews of member's care and health status of Applied Behavioral Analysis (ABA) services provided to determine medical appropriateness. Monitors clinical effectiveness and efficiency of member's care in accordance with ABA guidelines. Must reside in PST, MST, or CST time zone.

  Then Responsibilities:

  Responsibilities

  • Evaluates member’s care and health status before, during, and after provision of Applied Behavioral Analysis (ABA) services to ensure level of care and services are medically appropriate related to behavioral health (BH) and/or autism spectrum disorder needs and clinical standards.
  • Performs prior authorization reviews related to BH to determine medical appropriateness in accordance with ABA regulatory guidelines and criteria.
  • Analyzes BH member data to improve quality and appropriate utilization of services.
  • Interacts with BH healthcare providers as appropriate to discuss level of care and/or services provided to members receiving Applied Behavior Analysis Services.
  • Provides education to members and their families regarding ABA and BH utilization process.
  • Provides feedback to leadership on opportunities to improve care services through process improvement and the development of new processes and/or policies.
  • Performs other duties as assigned.
  • Complies with all policies and standards.
  Now Requirements/Qualifications: We have Education/Experience and License/Certification. Could be "Qualifications". Let's use

  Qualifications

  and include both education/experience and license/certification as
  • . Content: - Requires Graduate of an Accredited School of Nursing or Bachelor's degree and 2-4 years of related experience. - For Enterprise Population Health 2+ years providing ABA services as a BCBA License to practice independently, and/or have obtained the state required licensure as outlined by the applicable state (BCBA) required. - Master’s degree for behavioral health clinicians required. - Behavioral health clinical knowledge and ability to review and/or assess ABA Treatment Plans required. - Knowledge of ABA services and BH utilization review process required. - Experience working with providers and healthcare teams to review care services related to Applied Behavior Analysis Services preferred. - License/Certification: LCSW- License Clinical Social Worker required or LMHC-Licensed Mental Health Counselor required or LPC-Licensed Professional Counselor required or Licensed Marital and Family Therapist (LMFT) required or Licensed Mental Health Professional (LMHP) required or Board Certified Behavior Analyst (BCBA) required. - RN - Registered Nurse - State Licensure and/or Compact State Licensure. - RN - Registered Nurse- State Licensure and/or Compact State Licensure with BCBA required or Independent licensure with ABA experience and BCBA preferred. - Licensed Behavior Analyst (LBA) where required by state required. We need to avoid duplication: there are two lines about RN. We'll combine. Let's produce list items. Now Pay:

    Pay

    $27.02 - $48.55 per hour

    Add note about actual pay adjustment? That's extra detail but maybe part of Pay section. Could add a sentence: Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. That's substantive. We'll include as part of Pay section. Now Benefits:

    Benefits

    Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote,