Why the Texas Association of School Boards (TASB)
TASB comes from humble beginnings — picture a one-person organization created in 1949 to advocate for excellence in public education on behalf of Texas school board members. Flash forward to today, and we have over 500 employees working together to provide 1,024 school districts with purposeful resources and services so they can focus on what matters most — excellent education for over 5 million Texas students.
Our employees work alongside talented team members who are passionate about supporting public education and enjoy learning from new and different perspectives. TASB believes the rich variety of expertise our employees collectively bring to the workplace makes our organization highly successful. And TASB’s passion for education and learning doesn’t end there. Our culture has always encouraged employees to grow and become their best selves, professionally and personally, through a variety of innovative and collaborative development opportunities. You’re likely beginning to see why we’d been regularly named by the Austin Business Journal as one of the Top Ten Best Places to Work!
TASB offers competitive pay, rich benefits (including retirement matching of 2:1 up to 5% after one year, which means that if you contribute 5% to the plan, TASB will contribute 10%), family-friendly paid leave, onsite daycare, onsite gym, wellness program, tuition reimbursement, hybrid work options, and more.
Every role at TASB thoughtfully complements our mission and its impact on school districts across Texas. These roles include work in TASB’s Risk Management Services division, which provides administrative services to the TASB Risk Management Fund – a multi-line self-insurance pool (or “risk pool”) of Texas schools. If you consider your work exceptional, have a passion for risk management or risk pools, and want to help drive our mission forward, keep reading!
About You
As a Utilization Review Nurse Case Manager, you combine strong clinical judgment with a working knowledge of workers’ compensation requirements to help ensure claimants receive the right care at the right time and in the right setting. You’re skilled at evaluating requested services for medical necessity and appropriateness using ODG guidelines and communicating with providers to obtain timely, complete clinical documentation. You bring a collaborative, solutions-oriented approach to complex cases, partnering with internal teams to support safe, effective treatment while maintaining compliance with regulatory and payer requirements.
Required schedule is Monday-Friday; 9am-6pm
A Typical Day
- Evaluate requested treatment for workers’ compensation claimants using ODG guidelines, accepted standards of practice, and written criteria to support safe, appropriate care.
- Coordinate referrals to physician advisors, communicate with providers, peer review physicians, and adjusters, and document decisions accurately in the claims/risk management system while safeguarding PII.
- Participate in clinical discussions, team meetings, and department or company meetings and events as part of a collaborative Utilization Review team.
- If you’re still reading, we’d love to meet you!
How You’ll Make an Impact
- Complete utilization review and preauthorization requests for workers’ compensation claims, using ODG and clinical standards and documenting determinations clearly and consistently.
- Partner with claims adjusters and internal teams to answer medical questions, flag files appropriate for external case management referrals, and help coordinate appropriate care.
- Coordinate physician advisor reviews and peer review interactions, communicating with provider offices to obtain clinicals and keep determinations within required timeframes.
- Participate in claims review activities, including audit support and fee negotiation for workers’ compensation cases, as assigned, with an eye toward appropriate, cost-effective care.
- Preserve confidentiality and properly handle protected information and PII in accordance with applicable laws, regulations, and organizational requirements.
- Accurately and timely enter review information, determinations, and communications in the claims/risk management system and related applications.
- Provide input to update clinical criteria and stay current on accepted practices through continuing education and professional utilization/case management resources.
- Serve as the contact nurse on assigned internal nurse case management files that are medically complex, coordinating next steps with claims and clinical stakeholders.
Skills or Requirements For Success
Education and Experience
- Current vocational nurse (LVN) or registered nurse (RN) license to practice in the State of Texas.
- Minimum two years of clinical nursing experience; workers’ compensation utilization review experience preferred.
Knowledge, Skills, and Abilities
- Ability to evaluate requested treatment using ODG guidelines, accepted standards of practice, and written criteria to support objective, defensible determinations.
- Strong documentation skills, including timely, accurate entry in a complex claims/risk management software system and other applications.
- Comfort participating in claims review activities, including audit support and fee negotiation for workers’ compensation cases (as assigned).
- Commitment to maintaining licensure and staying current with accepted practices through continuing education and professional utilization/case management resources.
The TASB Difference
- Enjoy competitive pay and rich benefit offerings.
- Be a part of a collaborative environment where every contribution impacts Texas public schools.
- Thrive in a culture that promotes bringing your whole self to work every day and emphasizes healthy boundaries and work-life balance.
- Learn and grow individually and together through frequent professional development, wellness seminars, and more.
- Work alongside transparent leaders with an open and consistent feedback approach.
- Celebrate as a team with meaningful (and fun) events throughout the year.
Posting Notices
- The health and safety of our employees and members is our top priority.
- The Association is an equal opportunity employer and will not discriminate against an individual based on any of the following personal characteristics protected by law: race, color, national origin, religion, sex (including in relation to marital status, pregnancy, pay, sexual orientation, or gender identity), age, disability, genetics or veteran status.
- This position does not qualify for visa sponsorship.
- Any job offer is contingent upon receipt of result of a satisfactory background check.