Registered Nurse – Concierge Primary Care ClinicPosition Summary

Cloudberry Health; Santa Fe (NM); On-site; USD 75,000 - 105,000; Full time

Job summary

Cloudberry Health in Santa Fe, NM is seeking an energetic Registered Nurse to join a concierge primary care clinic. The RN will deliver personalized care, perform AWVs, CCM activities, education, and care coordination in a fast-paced, collaborative setting.

Ideal candidates will have strong communication, organizational skills, and the ability to operate independently while collaborating with physicians and staff. On-site clinic environment with a patient-centered approach.

Qualifications

• RN license in the applicable state is required.
• Strong clinical assessment and critical-thinking skills are essential.
• Excellent verbal and written communication with patients and team.

Responsibilities

• Provide personalized nursing care in a concierge primary care model.
• Perform AWVs and health risk assessments with preventive care planning.
• Manage CCM activities: outreach, coordination, documentation, and follow-up.
• Conduct patient assessments and monitor test results and medications.
• Triage over the phone and in-office; escalate urgent issues as needed.
• Educate patients on medications, treatment plans, and healthy lifestyles.
• Maintain accurate EMR documentation and coordinate referrals and testing.

Skills

Communication

Organization

Teamwork

Initiative

Attention to detail

Documentation

Education

RN license (state)

Job description

Registered Nurse – Concierge Primary Care Clinic

Position Summary

We are seeking a high-energy and highly organized Registered Nurse (RN) to join our concierge primary care team. This position is ideal for a nurse who enjoys building meaningful relationships with patients, takes initiative, communicates exceptionally well, and thrives in a fast-paced, collaborative environment.

The RN will play an integral role in delivering personalized, high-quality primary care while helping patients navigate their healthcare needs. The position includes Medicare Chronic Care Management (CCM), Annual Wellness Visits (AWVs), patient education, care coordination, clinical triage, and a broad range of standard nursing responsibilities. Ability to learn new technology and computer skills are fundamental.

Key Responsibilities

• Provide exceptional, personalized nursing care consistent with a concierge primary care model.
• Perform and assist with Medicare Annual Wellness Visits (AWVs), including health risk assessments, preventive care planning, screenings, medication reconciliation, and patient education.
• Manage Medicare Chronic Care Management (CCM) activities, including patient outreach, care coordination, monitoring, documentation, and follow-up.
• Conduct patient assessments, obtain vital signs, review medications, and identify changes in patient condition.
• Provide telephone and in-office triage and determine appropriate next steps based on patient needs.
• Communicate effectively with patients, families, providers, pharmacies, specialists, and other members of the healthcare team.
• Coordinate referrals, diagnostic testing and other aspects of patient care.
• Educate patients regarding medications, treatment plans, preventive care, chronic disease management, and healthy lifestyle choices.
• Assist providers with examinations, procedures, treatments, and other clinical needs.
• Perform nursing duties within the scope of practice.
• Maintain accurate, timely, and thorough documentation in the electronic medical record.
• Monitor and follow up on test results, patient messages, referrals, and other outstanding clinical items.
• Recognize and appropriately elevate urgent or concerning clinical issues.
• Help develop and maintain efficient workflows that enhance the patient experience and quality of care.
• Protect patient confidentiality and consistently follow clinical, regulatory, and organizational standards.
• Collaborate closely with physicians, advanced practice providers, medical assistants, administrative staff, and other team members.

Ideal Candidate

• A strong problem solver who can think independently and take appropriate action.
• Highly organized and able to prioritize multiple competing needs in a busy clinical environment.
• A team player who collaborates well with others and contributes to a positive workplace culture.
• High energy and positive attitude.
• Dependable, reliable, professional, adaptable, and willing to take initiative.
• An excellent verbal and written communicator who makes patients feel heard and valued.
• Able to adjust to change.
• Comfortable working independently while knowing when to ask for assistance or elevate an issue.
• Detail-oriented and committed to accurate documentation and follow-through.
• Compassionate and personable, with a genuine interest in developing long-term relationships with patients.

Qualifications

• Current Registered Nurse (RN) license in the applicable state.
• Prior primary care, ambulatory care, family medicine, internal medicine, or similar clinical experience preferred.
• Strong clinical assessment, communication, organization, and critical-thinking skills.
• Experience with Medicare Chronic Care Management and/or Annual Wellness Visits preferred.
• Ability to work effectively in a team-oriented, patient-centered environment.