What is the Difference?

Nurse Navigator most often work in a single medical/surgical specialty or "Service Line."

They are often involved from the point of a suspicious finding or planned surgery through diagnostic testing, treatment, and follow-up or end-of-life care. The nurse navigator responds to questions in a timely manner, explains the rationale behind the planned treatment, and coordinates care across the healthcare continuum.   Common specialties that have Nurse Navagators include Bariatrics, Heart and Vascular Care,  Oncology, Orthopedics, Surgery, Transplant to name a few.

RN Care Coordinator/ Patient Care Coordinators act as the mediator between patients and the medical teams treating them. Their priority is ensuring that patients get the care they require, often helping patients understand their treatment options, develop a plan for achieving their health goals and stay on track with taking medications.  They act as discharge planning advocates identifying most appropriate next level of care post hospitalization: SNF, Rehab, LTC placement or discharge to home.  They communicate with insurance companies for authorization of hospital admission and followup care needs.  Coordinator will arrange for needed  Durrable medical equipment  IDME)+ needed medical prescription for such supplies (walker, hospital beds, Oxygen, glucometers, etc, ) arrange for IV infusion TX,  and home health services. 

In the Emergency Department, they help identify resources that may allow patient to be cared for at home versus hospitalization.  Reduce readmissions and manage episodes through real-time notifications of ED visits to insurance companies.   Post performing  a coordination  assessment,  RN's will understand and act upon patients’ social determinants of health to support and address their non-clinical needs. Can patient pay for electricity to run their oxygen concentrator or air conditioner to avoid COPD readmission or is their a community fund/program that may pay the cost to prevent future readmission?

Coordinators notify Primary Care Provider (PCP)/Specialists of hospital admissions and discharges to arrange for follow-up visit desired within next 2 wks and identifies any transportation needs to get to next level of care.

Nurse Case Managers inpatient may function as an RN Care Coordinator. Otherwise, they will manage a select group of patients both inpatient and followup that outpatient services arranged have occurred.   Provide telephonic post-discharge support to assist a defined population of patients in meeting short-term needs to prevent readmissions.  Did patient get medication prescriptions filled, have followup PCP/Specialist visits occurred,  do they need any medical supplies?  Are referrals needed?   Case Manager will follow-up that lab work performed and may monitor results.  In Cardiologist office/clinics provide coumadin management,  will monitor PT/INR, adjusting dosage under standing orders. 

Outpatient Case Managers include:   

Working for Insurance companies- Responsible for telephonic and/or face to face assessing, planning, implementing and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member’s overall wellness. Develop a proactive course of action to address issues presented to enhance the short and long-term outcomes as well as opportunities to enhance a member’s overall wellness.  Services strategies policies and programs are comprised of network management and clinical coverage policies.   Provide patient advocacy for options and services to meet an individuals benefit plan and/or health care needs.

Home  Health Care Nurse Managers perform many functions of RN Care Coordinator --with a lot more paperwork due to Medicare/Medicaid/insurance regulations --- OASIS assessment is  a comprehensive assessment designed to collect information on nearly 100 items related to a home care recipient's demographic information, clinical status, functional status, and service needs performed at start of care, reassessment post readmission hospital and 60 day recertification.

RN performs in-home visits focused on patient assessment, teaching, and car; Identifies and develops specific plans of care;  Performs patient care including wound care, lab draws, and IV administration as needed.                                        

the RN coordinates the implementation of all home care services, which includes nursing, physical therapy, occupational therapy, speech therapy and personal care services, to ensure that quality service is provided to meet client needs.  Arranges/Orders needed Durable Medical Equipment.  Participates in Interdisciplinary Team Meetings.  Supervises Home Health Aides -every 2 weeks for Medicare/Medicare Managed Care to every 2 months for non-medical patient care services.

On 3/10/2021 at 8:26 AM, londonflo said:

Where I worked the Case Managers had years of experience as floor nurses (diploma, ADN and BSN) with getting patients ready for discharge. I read here students applying for $$$$ programs like Samuel Merritt College for a graduate level case managment degree. 

In California, does one need a MSN for a case managment position?

No. But put a snippety price tag on it and use the right mumbo jumbo in your advertising and someone in California will buy it.