Medicare Qualification Specialist - Registered Dietitian

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Job Purpose and Summary:

The Dietitian is responsible for providing safe, high-quality, patient-centered nutrition support services, including parenteral nutrition and enteral tube feeding, in accordance with company policies and procedures, accepted standards of nutrition practice, and the physician’s treatment plan.

The Dietitian reviews clinical documentation to determine qualification under Medicare standards and supports documentation needed for payer requirements and reimbursement. This role collaborates with internal and external customers to support smooth transitions to Coram CVS/speciality infusion services, continuity of care, and ongoing customer satisfaction. As a subject matter expert, the Dietitian supports mentoring and training for RDs and non-clinical staff, operational and clinical report development and analysis, program initiatives, and scheduling activities as assigned by the Supervisor or Manager-Dietitian Nutrition Support.

Work Location

• This is a work from home position and one may live anywhere in the Eastern, or Central Time Zone.

Primary Job Duties & Responsibilities:

Maintain accurate and complete clinical documentation to support patient care, medical necessity, payer requirements, and reimbursement processes.

• Assist with qualification and documentation of medical necessity for parenteral and enteral therapies across applicable payers.
• Support ongoing path-to-payment conversations with prescribers and patients to substantiate insurance claims for nutrition therapies and support reimbursement.
• Support the appeals process as needed.

Collaborate with internal and external partners to support optimal patient care, provide education on nutrition support services, and promote ongoing learning related to Coram CVS/specialty infusion programs, policies, and processes.

• Assist with educating internal staff and external customers on appropriate nutrition therapy, nutrition policies and procedures, and reimbursement-related topics.
• Lead or participate in nutrition support team meetings and patient care conferences, contributing appropriate clinical information.
• Provide patient and caregiver instruction related to medical nutrition therapy at home as ordered by the physician.
• Partner with sales and business partners, as appropriate, to provide clinical expertise related to nutrition support services, customer education, and growth opportunities.

Required

• 1+ years of experience as a Registered Dietitian working with nutrition support (i.e., Enteral and TPN).
• Knowledge of applicable state clinical and regulatory requirements.
• Current license as a Registered Dietitian in the state of residence, where required
• Willingness to obtain additional state licensure as needed to support patient care needs
• Working knowledge of Microsoft business software
• Strong verbal and written communication skills, including the ability to provide clear instructions to patients, caregivers, healthcare providers, and internal partners, and to complete accurate clinical documentation.
• Experience providing exceptional customer service by responding to medical professionals and patients with accurate and timely information.
• Strong problem-analysis and decision-making skills.
• Ability to address and resolve conflict effectively.
• Ability to work effectively in teams and coordinate work efforts across multiple stakeholders.
• Excellent organizational and time management skills.
• Ability to manage competing priorities in a high-volume, fast-paced clinical environment
• Ability to perform additional duties as assigned by the supervisor or manager.

Preferred Qualifications: 

• Experience providing home nutrition support care.
• Certified Nutrition Support Clinician (CNSC) for those with direct patient assessment/clinical care responsibilities.
• Knowledge of payer requirements related to billing and reimbursement.
• Experience using electronic medical record systems.

Education: 

• Bachelor’s degree in Nutrition, Dietetics, or a related field.

Anticipated Weekly Hours

Time Type

Pay Range

The typical pay range for this role is:

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls.  The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.  This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. 
 

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

Additional details about available benefits are provided during the application process and on Benefits Moments.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.