Every person shown in a sequence links to one real service, enabling, clinical-leadership, legal, participant, or outside category. The selected step states the exact work and entry trigger. Software and records appear separately.
Each selected diagram step shows the exact function and entry condition; the linked SOP carries the full procedure.
People who furnish or support GUIDE services
L1
Philippine 24/7 and coordination support
Proxi's Philippines-based human first-answer and administrative support team.
$5.50/hour planning assumption · July 14, 2026
Functions this category may perform
24/7 human first answer, identity and callback capture, and warm transfer
Scheduling, record pursuit, endpoint verification, structured intake, and failed-route recovery
Source-faithful documentation and permitted administrative follow-through
Authority
Performs approved nonclinical first-answer and administrative acts.
Hard boundary
Not a GUIDE navigator contact and never clinical triage, medication reconciliation, treatment, or U.S.-licensed work. A Philippine RN credential does not expand this lane.
Puerto Rico-based nonclinical dementia care navigator with current Alzheimer’s Association® essentiALZ® certification for dementia care navigation.
$22/hour all-inclusive planning assumption · July 14, 2026
Functions this category may perform
Primary relationship, required GUIDE contact, and beneficiary-led care-plan facilitation
Nonclinical assessment contribution, caregiver training/support, community coordination, and warm introductions
Human clarification for ambiguity, disagreement, distress, accessibility failure, or requested relationship help
Authority
Performs the specifically required or valuable nonclinical human GUIDE act after preparation.
Hard boundary
No clinical or medical work, even if an individual also holds an RN or other professional credential. Not the default fact collector, option builder, or gateway to a clinician.
A dementia-proficient NP, PA, CNS, physician, or other exact prescribing/E/M professional authorized for the beneficiary location and act.
$140/hour planning assumption · July 14, 2026
Functions this category may perform
Required examination and clinically necessary history
Diagnosis, staging, treatment, medication reconciliation, prescribing, and medical orders
Higher-authority clinical contribution to assessment, care planning, transitions, and follow-up
Authority
Exercises only the medical and prescribing authority actually held by the named professional.
Hard boundary
Receives a prepared source-linked packet; routine record hunting, form population, scheduling, and administrative chasing occur before this role enters.
The administrative subject-matter professional for state Medicaid benefits, waivers, coverage authorities, eligibility interfaces, and Medicaid responsibility questions.
Concrete work
Resolve a bounded Medicaid program or coverage-authority question
Identify the authoritative state, plan, waiver, payer, or agency source
Separate Medicaid responsibility from GUIDE and claim-processing work
Authority
Interprets the approved Medicaid program materials within assigned administrative scope.
Hard boundary
Not a clinician, navigator, eligibility adjudicator beyond delegated authority, or second revenue-cycle queue.
No routine diagram assignment
This job enters through a concrete failure or escalation route, not as a standing reviewer.
These leaders enter only for the issue inside their actual authority. They do not bless routine work.
Escalation authority
Head of nursing and clinical operations
The U.S. nursing leader accountable for nursing-practice quality, RN clinical operations, and escalations beyond the original nurse or first-line clinical supervisor.
Concrete work
Review a serious or repeated RN-practice issue
Set and correct nursing-practice and clinical-operations standards
Assign the responsible nursing correction and verify recovery
Authority
Exercises nursing leadership within actual organizational, licensure, and jurisdictional authority.
Hard boundary
Not a reviewer for administrative, navigator, billing, privacy, software, or physician-quality work.
The physician executive used for physician/medical quality, high-level medical judgment review, and medical-staff accountability when the issue exceeds the original clinician.
Concrete work
Review a serious physician or medical-quality issue
Resolve high-level medical-practice escalation within actual authority
Assign the responsible medical correction and verify its disposition
Authority
Exercises physician medical leadership within the CMO's actual organizational and professional authority.
Hard boundary
Not a rubber stamp for routine care plans, RN work, missed callbacks, staffing gaps, or administrative failures.
No routine diagram assignment
This job enters through a concrete failure or escalation route, not as a standing reviewer.
The named person or body inside the GUIDE Participant that retains a nondelegable approval, signature, attestation, or organizational accountability act.
Functions
Participant-retained approval, attestation, signature, or final accountability
Assignment and oversight required by the Participation Agreement or approved policy
Reviewer-visible subtype or participation basis
Exact retained Participant body
Exact retained approval, release, signature, attestation, or accountability act
Authority
Performs only the exact act that cannot be delegated or that the Participant has expressly retained.
Boundary
Not automatically the navigator or clinician and not a universal approver. Exact unresolved authority remains an open decision rather than a placeholder role.
The typed outside endpoint that controls an external act: PCP, specialist, pharmacy, hospital/facility, emergency service, payer, community organization, Medicaid/AAA/Tribal Aging Program, or contracted field professional.
Functions
Co-management, concurrence, direct treatment, dispense, coverage/intake decision, emergency response, or real-world service delivery
Returns source-native evidence of the outside result or truthful non-success
Reviewer-visible subtype or participation basis
PCP or primary care practice
Specialist, prescribing clinician, diagnostic provider, or laboratory
Pharmacy, supplier, hospital, facility, home-health, or hospice organization
Emergency, crisis, poison-control, or protective-service responder
Payer, Medicaid HCBS program, AAA, or Tribal Aging Program
Community service, caregiver support, training, transportation, interpreter, accessibility, or communications provider
Authority
Controls only the external decision or performance within that party's real role.
Boundary
Proxi may prepare, connect, pursue, and report; it cannot manufacture the external result from a send, appointment, claim, or acknowledgement. An external system is channel metadata for the typed endpoint, not a person or a Proxi software surface.
Each linked legacy function opens its definition, permitted role families, and controlling procedure instead of creating a phantom actor.
Function assignment
Assessment team or owner
The people accountable for the particular assessment act, not one standing job title.
How the exact person is selected
Resolve each task to the Puerto Rico navigator, exact U.S. RN, behavioral clinician, medical clinician, beneficiary/caregiver, or outside source shown in that assessment step.
The canonical person assigned the particular Care Plan action or protected contribution.
How the exact person is selected
The beneficiary leads choices; the navigator facilitates and owns nonclinical follow-through; an exact U.S. clinician owns protected clinical judgment; outside or Participant acts stay with those parties.
The canonical performer of the applicable caregiver education, support, training, or protected clinical contribution.
How the exact person is selected
Most relationship and application work resolves to the Puerto Rico navigator; clinical questions resolve to the exact U.S. clinician; contracted real-world training may resolve to an outside provider.
A function requiring actual prescribing authority for the beneficiary location and act.
How the exact person is selected
It resolves to Proxi's exact U.S. L4 clinician only when Proxi supplies that clinician; otherwise it resolves to the typed outside prescribing clinician.
Nursing quality goes to the Head of nursing, physician or medical quality to the CMO, and a genuine uncovered legal question to healthcare counsel. The affected act remains held.
Run the approved software rule and keep the original worker responsible for ordinary completion or correction.
If human recovery is needed, use that worker's named lane lead before creating work for another department.
Classify the remaining issue by the observable work: system operation, software defect, claim, Medicaid, workforce, nursing quality, medical quality, or legal interpretation.
Assign one named rostered person from the matching real job category and state the exact input, act, output, due time, and return recipient.
Keep portfolio work outside the beneficiary episode. HR roster repair, system incidents, and QA sampling do not become furnished GUIDE services.
If no real role has the required authority, hold only the affected act and resolve the policy or organizational gap before field use.
Routine work correction
Human category
The original worker; then that worker's Philippine, Puerto Rico, or clinical lane lead
Person enters when
A handoff, callback, service record, or assigned action remains incomplete after the approved automated retry
Work
Correct the original work inside the same lane; the lead enters only after the defined repeat-failure or dispute threshold.
Output
Corrected work, named next action, due time, and recovery evidence.
Episode boundary
Beneficiary episode. Quality is a responsibility of the applicable lane lead, not a separate case specialist.
A state Medicaid benefit, waiver, coverage authority, eligibility interface, or Medicaid responsibility question cannot be resolved from the approved rule and verified facts
Work
Resolve the bounded Medicaid program question or identify the authoritative outside source needed.
Output
Cited Medicaid disposition, missing source, or external referral; no GUIDE clinical decision.
Episode boundary
Program expertise. This is not a second billing queue.
Return rule: the enabling or escalation role returns its result to the service worker responsible for the affected action. It does not take over the beneficiary relationship.
Preparation and orchestration are visible, but they never borrow human authority.
01
Proxi Daily Companion
Configurable daily beneficiary interaction, approved information, reminders, action help, source-attributed self-report, and a direct request for a person.
Boundary
Not a qualifying navigator contact, 24/7 human first answer, clinical monitor, diagnosis, urgency decision, or service-completion event. Silence stays unknown.
02
Caregiver Companion View
Permission-scoped, source-dated last-confirmed beneficiary information, open actions, explicit unknowns, a fresh-check request, and an optional caregiver pulse.
Boundary
Does not expose unauthorized information, convert caregiver observation into beneficiary fact, score distress, or present synthetic clinical status. Silence, stale data, and conflict remain unknown and never become reassurance.
03
Staff Preparation and AI Workspace
Retrieval, source links, contradictions, unknowns, prior promises, approved explanations, options, summaries, and the exact unresolved question.
Boundary
Prepares and advises within approved content; it does not resolve the question, choose for the person, or prove human review.
04
Deterministic Routing and Takeover
Approved routing, no-repeat context transfer, retries, failed-handoff recovery, and preservation of the original issue.
Boundary
AI cannot select clinical urgency, authority, disclosure, service credit, or closure.
05
Action and Result Tracker
Promises, owners, deadlines, external responses, receiving acceptance, due work, returned results, corrections, and affected-pillar feeds.
Boundary
A send, alert, appointment, handoff, named owner, or dashboard state is not completion.
Proxi product layer · not a ninth pillar
Daily companion and caregiver pulse
Daily availability feeds the right service; it does not manufacture one.
Verify identity and permission.Use the person's current scope, not family relationship or old access.
Show the last confirmed picture.Every material item carries its source and as-of time; unknown stays unknown.
Offer a beneficiary interaction.The beneficiary may participate, defer, decline, or ask for a person.
Ask the optional caregiver pulse.Capture how the caregiver is holding up and whether help is wanted as caregiver-owned information.
Prepare; do not decide.Proxi retrieves context, preserves exact reports, and raises configured stop candidates.
Route to the real performer.L1, L2, the exact L3/L4 professional, a concrete enabling department or escalation authority, or the outside endpoint completes the named work and returns a disposition or source-native evidence.
Return one action plan.State what happened, which canonical actor is assigned each action, what remains unknown, and when the result is expected.
No response is not stability. Companion activity alone is not a human GUIDE contact, 24/7 human answer, caregiver assessment or support call, clinical assessment, or service credit.
Mechanical reviewer check
If a name does not resolve here, it is a phantom actor.
A diagram assigns concrete work and an entry condition to a canonical person. It may name the exact capacity or outside subtype used in that step. It may not create a new person from a function, combine software and a human into one label, or put a ledger, packet, calendar, route, or work queue in the actor lane.
A linked function phrase in a source manual returns here when the exact performer depends on the episode or an open authority decision. The selected diagram step must resolve that function to the applicable canonical actor and state the work performed; the function link itself never claims a new person.