Resources for care teams
By MySeema · Published November 10, 2026
What is care navigation?
Care navigation is hands-on help getting a patient through the healthcare system, from the appointment to the ride, the refill, and the follow-up.
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What is care navigation?
Care navigation is hands-on help getting a patient through the healthcare system: scheduling appointments, arranging referrals and transportation, sorting out insurance and paperwork questions, and following up until each next step is done. A navigator handles the practical work. Clinicians keep the medical decisions.
What a care navigator does
- Reaches out to patients and stays in contact between visits.
- Schedules appointments and follows referrals until they are completed.
- Helps with practical barriers such as transportation, refill requests, and insurance questions.
- Documents what happened and brings clinical questions back to the care team.
A navigator does not diagnose, prescribe, or change treatment. Those decisions stay with the treating clinicians.
Care navigation, care coordination, and care management
| Term | What it means | Example |
|---|---|---|
| Care navigation | Hands-on help for one patient with the practical path through care | Booking a specialist visit and arranging the ride to it |
| Care coordination | Organizing care and sharing information among the clinicians and offices involved | Making sure the cardiologist’s notes reach the primary-care practice |
| Care management | A structured program for a defined group of patients, built on a care plan | Chronic Care Management for patients with two or more chronic conditions |
Organizations use these terms differently, and the work overlaps. What matters in practice is who does each task, who oversees it, and where it is documented.
What is the difference between care navigation and care management?
Care navigation is the practical help a patient receives. Care management is the structured program around it, built on a care plan for a defined group of patients, such as Medicare’s Chronic Care Management or Transitional Care Management. A care-management program often includes navigation, and navigation can also continue for patients who fit no program.
Does Medicare pay for care navigation?
Medicare pays for specific services that include navigation when their requirements are met. Principal Illness Navigation covers patients with a serious, high-risk illness, and Community Health Integration covers unmet social needs that interfere with medical care. Both start with an initiating visit and require consent and supervision. PIN guide · CHI guide
Who uses care navigation
Health systems, ACOs, payers, and physician practices use navigation to keep patients connected between visits and to carry the follow-through their own staff do not have time for. For organizations and networks · For physician practices
Individuals and families use navigation for help around doctor appointments, questions, and next steps. For individuals and families
Related guides
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