- Specialty: Utilization Review
- Job type: Full-time
- Salary: $26 – $57 / hr
- License states: Any US
This role is no longer accepting applications.
GDIT closed this listing in September 2026. The listing stays up for reference — the roles below are open right now.
Applications closed
More open utilization review positions — or browse every utilization review role.
Loading related roles…
At a glance
Remote RN medical policy review for the World Trade Center Health Program (NIOSH/CDC), supporting coverage determinations and coding integrity. Evaluates CPT, HCPCS, ICD-10, and MS-DRG codes against clinical evidence, medical policy, and CMS guidance. Requires an associate degree in nursing, an active RN license, and 5
Regular
None
None
MBI (T2)
Administration
Clinical Documentation, Documentation Review, Medical Billing and Coding, Medical Coding, Medical Documentation
None
5 + years of related experience
No
The World Trade Center Health Program is a limited federal health program administered by the National Institute for Occupational Safety and Health (NIOSH), part of the Centers for Disease Control and Prevention (CDC) in the U.S. Department of Health and Human Services (HHS). The Program provides no-cost medical monitoring and treatment for certified WTC-related health conditions to those directly affected by the 9/11 attacks in New York, the Pentagon, and in Shanksville, Pennsylvania
The Medical Policy Review Nurse will contribute to the strategic direction of the business and support impactful mission outcomes as an Medical Policy Review Nurse at GDIT. Here, you’ll enable the success of one of the most critical federal healthcare missions and ensure accurate, clinically‑supported coverage determinations for the World Trade Center Health Program. This position will be impactful to the mission of the World Trade Center Health Program (WTCHP). You will play a crucial role in bridging clinical judgment and coding accuracy to ensure coverage, authorization requirements, and claims integrity align with clinical documentation, medical policy, coding standards, and federal regulatory requirements.
● Lead the evaluation of CPT, HCPCS Level II, ICD‑10‑CM/PCS, MS‑DRG, revenue, and other codes against clinical evidence, benefit language, medical policy, and regulatory guidance to support coverage determinations.● Collaborate with Medical Directors, Utilization Management staff, coding/compliance teams, product teams, and policy analysts to ensure coding and coverage logic remain clinically appropriate, operationally feasible, and compliant.● Drive high‑quality clinical and coding outcomes by performing code validations, identifying incorrect or inconsistent usage, recommending prior authorization requirements, supporting audits, and advising on emerging procedures, technologies, and regulatory changes.● Utilize coding guidelines, clinical literature, CMS NCD/LCDs, medical necessity concepts, and utilization management criteria to develop evidence‑based recommendations for coverage, authorization, and coding treatment.
Bring your initiative and clinical/coding expertise to GDIT. The Medical Policy Review Nurse must have:
● Education: Associate degree in Nursing required; bachelor’s degree preferred● Experience: Registered Nurse with demonstrated experience in medical coding, medical policy, utilization management, claims, reimbursement, or clinical documentation review● Technical skills:
Benefit/coverage concepts● Certifications: CPC, CCS, CCA, CRC, or equivalent preferred● Security clearance level: MB(T2)● Role requirements: Ability to conduct detailed clinical coding reviews, evaluate medical documentation, research complex clinical/coding subjects, interpret medical policy, and collaborate across clinical, operational, and coding teams; Must have prior supervisory and/or team management experience
At GDIT, the mission is our purpose, and our people are at the center of everything we do.:
● Growth: AI-powered career tool that identifies career steps and learning opportunities● Support: An internal mobility team focused on helping you achieve your career goals● Rewards: Comprehensive benefits and wellness packages, 401K with company match, competitive pay, and paid time off● Flexibility: Full-flex work week to own your priorities at work and at home● Community: Award-winning culture of innovation and a military-friendly workplace
Explore a career at GDIT and you’ll find endless opportunities to grow alongside colleagues who share your passion for advancing clinical accuracy, coding integrity, and mission‑critical healthcare delivery.
The likely salary range for this position is $85,093 - $115,000. This is not, however, a guarantee of compensation or salary. Rather, salary will be set based on experience, geographic location and possibly contractual requirements and could fall outside of this range.
40
Less than 10%
Remote
Any Location / Remote
Join our Talent Community to stay up to date on our career opportunities and events atgdit.com/tc.
Tags