Medicare Qualification Specialist - Registered Dietitian

CVS Health•Work At Home-Indiana, IN

1d•$21 - $44•Remote

About The Position

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. 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.

Requirements

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.

Nice To Haves

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.

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.