The individual will provide primary care-focused pharmacotherapy services to evaluate and manage patients with complex chronic primary care conditions (e.g., CKD/ESRD, Type 2 diabetes, hyperlipidemia, hypertension, COPD/Asthma) through direct patient care, as appropriate. Monitors, analyzes, and addresses ACO quality performance trends by identifying care gaps, implementing targeted medication management interventions, and collaborating with interdisciplinary teams to improve clinical outcomes and quality measure performance.