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Personas, access groups, and access roles

Updated on January 6, 2022

Pega Care Management's enhancement of the Interaction portal further aligns Pega Care Management with the CRM work paradigm. This allows for access to features such as Interactive Voice Response with Intelligent Virtual Assistant (IVR-IVA), Chat, and outbound calling. The emphasis on personas, access groups, and access roles means that only cases, dashboards, and the navigation pane features are visible based on the specific persona.

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Persona details for payers, providers, and non-clinical personnel

Details including access groups, access roles, and privileges are provided for Pega Care Management out-of-the-box personas.

Note: If there is a need to reference the earlier personas, see Pega Care Management access roles and privileges.

The following table shows the out-of-the-box personas, including the access groups for the core application, the access roles, and the operators.

PersonaAccess group (Core)Access rolePrivilege
ConfiguratorCareManagement _8: ConfiguratorsCareManagement_8: ConfiguratorsCareManagement_8: Configurators
Payer_Care ManagerCareManagement _8: Payer_CareManagersCareManagement_8: Payer_CareManagerCareManagement_8: CareManagers, PatientServicesUser
Provider_Care ManagerCareManagement _8: Provider_CareManagersCareManagement_8: Provider_CareManagerCareManagement_8: CareManagers
Provider_NurseCareManagement _8: Provider_NursesCareManagement_8: Provider_NurseCareManagement_8: Provider_Nurse
Provider_PharmacistCareManagement_8: Provider_PharmacistsCareManagement_8: Provider_PharmacistCareManagement_8: Provider_Pharmacist
Provider_Social WorkerCareManagement _8: Provider_SocialWorkersCareManagement_8: Provider_SocialWorkerCareManagement_8: Provider_SocialWorker
Payer_MedicalDirectorCareManagement _8: Payer_MedicalDirectorsCareManagement_8: Payer_MedicalDirectorCareManagement_8: MedicalDirector, PatientServicesUser
Payer_Care CoordinatorCareManagement _8: Payer_CareCoordinatorsCareManagement_8: Payer_CareCoordinatorCareManagement_8: CareCoordinators, PatientServicesUser
Provider_Care NavigatorCareManagement_8: Provider_CareNavigatorsCareManagement_8: Provider_CareNavigatorCareManagement_8: Provider_CareNavigator
AdministratorsCareManagement_8: AdministratorsCareManagement_8: AdministratorCareManagement_8: Administrators
Payer_UM CoordinatorCareManagement_8: Payer_UMCoordinatorsCareManagement_8: Payer_UMCoordinatorCareManagement_8: Payer_UMCoordinator, PatientServicesUser
Payer_UM ManagerCareManagement_8: Payer_UMManagersCareManagement_8: Payer_UMManagerCareManagement_8: Payer_UMManager, PatientServicesUser
Payer_Customer SupportUserCareManagement_8: Payer_CustomerSupport UsersCareManagement_8: Payer_CustomerSupport UserCareManagement_8: CustomerSupportUser, PatientServicesUser
Provider_Customer SupportUserCareManagement_8: Provider_Customer SupportUserCareManagement_8: Provider_Customer Support UserCareManagement_8: CustomerSupportUser
Payer_Customer SupportManagerCareManagement_8: Payer_CustomerSupport ManagersCareManagement_8: Payer_CustomerSupport ManagerCareManagement_8: CustomerSupportManager, PatientServicesUser
Provider_Customer SupportManagerCareManagement_8: Provider_Customer Support ManagersCareManagement_8: Provider_Customer SupportManagerCareManagement_8: CustomerSupport Manager
Provider_Clinical AdministratorCareManagement_8: Provider_Clinical AdministratorsCareManagement_8: Provider_Clinical Administrators CareManagement_8: Provider_Clinical Administrators
Provider_Medical DirectorCareManagement_8: Provider_Medical DirectorsCareManagement_8: Provider_Medical DirectorCareManagement_8: MedicalDirector
Payer_Care TriageCareManagement_8: Payer_CareTriageCareManagement_8: Payer_CareTriage ManagedCareManagement_8: Payer_CareTriage

Persona access to the navigation pane

In Pega Care Management, features are displayed in the navigation pane based on the persona.

The following table shows the parts of the navigation pane that personas with the specified role can access:

Access to the navigation pane

Access roleMy workDashboardManager toolsPulseTagsSpacesMy reportsApplication toolsMDM AgendasTools
Care TriageXXXXCM
Care Manager (payer)XXXXCM, INXX
Medical DirectorXXXXAllX
Care CoordinatorXXXXCM, INX
UM CoordinatorXXXXUM, IN
UM ManagerXXXXUM, INXX
Customer Support UserXXXXAllXX
Customer Support ManagerXXXXXAllXXX
Care Manager (provider)XXXXCM, INX
Nurse PharmacistXXXXCM, INX
Social WorkerXXXXCM, INX
Clinical administrative supportXXXXCM, INXX
Medical director (provider)XXXXAllX
Care NavigatorXXXXCM, INX
Customer Support User (provider)XXXXAllXX
Customer Support Manager (provider)XXXXXAllXXX

Persona access to dashboards

In Pega Care Management, for each persona, there is a pre-configured out-of-the box dashboard. The persona can view the data associated with a dashboard report and take action.

PersonnaDashboard
Payer_CareTriage
  • Open cases
  • Assignments within SLA
  • Interaction summary by channel
  • Case volume
Payer_CareManager

Provider_CareManager

Provider_Nurse

Provider_Pharmacist

Provider_SocialWorkers

Provider_ClinicalAdministrator

  • My assessments
  • Upcoming visit
  • Resolved cases within SLA
  • Active members by program
  • Care gap measures
Payer_MedicalDirector

Provider_MedicalDirector

  • Authorization reviews within SLA
  • Upcoming peer to peer reviews
  • Active patients by care program
  • Care Gap Measures
Payer_CareCoordinator

Provider_CareNavigator

Payer_UMCoordinator

  • Open cases
  • Assignments within SLA
  • Interaction summary by channel
  • Case volume
Payer_UMManager
  • Auth req by type and status-current month  
  • Pending Authorization requests by request type and pend status
  • Denied auth by auth type and reject reason code- Current year
  • Denied admissions by reject reason code- Current year"
  • open cases
  • Upcoming peer to peer reviews
  • Use Denied Auths by MD
  • Overturn denials by MD
Payer_CustomerSupportUser

Provider_CustomerSupportUser

  • My assessments
  • Upcoming visit
  • Resolved cases within SLA
  • Active members by program
  • Care gap measures
  • Visits scheduled
Payer_CustomerSupportManager

Provider_CustomerSupportManager

  • Visits scheduled by team
  • My assessments
  • Declined programs
  • Assignments within SLA
  • Interaction summary by channel
  • Active patients by care program
  • NPS across channel
  • My team's net promoter score
  • My team's first contact resolution

Tags

Pega Care Management 8.7

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