Cancer and cancer therapies dramatically impact nutritional status, leading to malnutrition and weight loss. Cancer centers struggle with inadequate staffing of oncology certified Registered Dietitian Nutritionists (RDN) to provide appropriate nutritional care. Evidence suggests RDN interventions can increase lean body mass, enhance weight maintenance, promote quality of life, and improve cancer treatment adherence. There is, however, limited literature about practical approaches to RDN staffing models for ambulatory cancer centers. The Atrium Health Levine Cancer Section of Oncology Nutrition was formalized in 2016 and now consists of 15 RDNs across 23 practice locations. In 2022, 14 clinical RDNs and one Wellness RDN completed over 16,000 encounters across 9,700 new and established patients. The RDNs are involved with nutrition and wellness education, quality improvement projects, subspeciality integration, and telenutrition. We describe the history and organization of a successful clinical and academic Section of Oncology Nutrition within a major multisite cancer center. We also review challenges and lessons learned regarding this important and novel development.