Pediatric Care Coordination Resource Guide
Understanding Care Coordination, Care Management and Case Management:
Care Coordination
Care Coordination refers to the coordination of care at the system level, such as identifying referral pathways and resources for entire patient populations.
Care Management and Case Management
Care or Case Management occurs at the patient or family level and, as defined by the Case Management Society of America, is a collaborative process of assessment, planning, facilitation, care coordination, evaluation and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote patient safety, quality of care, and cost effective outcomes.
These services may be performed by a nurse or social worker, depending on the patient’s and family’s needs. In the MaineHealth system, care and case management terms are often used interchangeably and can occur in various settings (inpatient, home care, ambulatory, community). Individuals whose position titles are Care Manager or Case Manager can also have unique roles and responsibilities based on the population served and agency expectations. In certain communities, a Care Coordinator position may also provide care or case management services.
What Resources are available for patients in your region?
Points of contact in each region have taken on the responsibility for maintaining updated lists of care and case management resources in that area. See the table below and on the next page for your contact(s):
Region | Point Position | Current Individual | Contact Info |
---|---|---|---|
FCHC | Franklin Pediatrics RN Care Coordinator |
Sandy Richard | sandy.richard@mainehealth.org 207-778-0482 |
LincolnHealth | Practice Manager Family Medicine, Internal Medicine, Pediatrics |
Sarah Harper | sarah.harper@mainehealth.org 207-563-4746 |
MaineGeneral |
Kennebec Pediatrics Social Worker | Lynn Jackson | lynn.jackson@mainegeneral.org 207-626-6311 |
Supervisor, CCT | Jessica Nalesnik | jessica.nalesnik@mainegeneral.org | |
Memorial | TBD | TBD | TBD |
Mid Coast |
RN Clinical Manager, Mid Coast Pediatrics | Shanna Swan | shanna.swan@mainehealth.org 207-721-8333 Fax: 207-798-4618 |
Care Coordinator, Mid Coast Medical Group at Parkview | June King | jking@midcoasthealth.com | |
CHANS Home Health | Sarah Bloy | sarah.bloy@mainehealth.org | |
Pen Bay | PenBay Pediatrics RN Care Coordinator | Jessica Bowen | jessica.bowen@mainehealth.org 207-301-5635 |
SMHC | Central Navigation |
ctiliaison@mainehealth.org |
|
St. Mary's |
Nurse Care Manager, CCS Pediatrics | Sarah Ranger, RN | sarah.ranger@mainehealth.org |
Social Worker, Women’s Health Associates, Family Birthing Unit, and Pediatrics | Bethany Merrill, LSW | bmerrill@stmarysmaine.com | |
Practice Manager | Kristy Gelinas, LCSW | kgelinas@stmarysmaine.com | |
WCHC | Care Coordinator | Stacey Hall | stacey.hall@mainehealth.org 207-505-4797 |
WMH | Western Maine Pediatrics Care Coordinator |
Nina Douglas |
nina.douglas@mainehealth.org sheila.seamans@mainehealth.org 207-743-8766 |
MMC/MMP | Central Navigation |
ctiliaison@mainehealth.org |
Contact Information
Payer |
Contact Information to Determine Access and/or Make Referral |
---|---|
Aetna |
For HMO-based plans and all Medicare Advantage plans: call 800-624-0756 |
Anthem |
Call Provider Services at 800-676-2583 |
Cigna |
Call Provider Services at 800-926-2273 |
Harvard Pilgrim |
Members can be referred to our programs by contacting us at 866-750-2068. Please leave the following information. Member full name, date of birth, HP insurance number, best number to reach member (i.e. cell phone number) and brief reason for the referral. The member will be called within 1 business day. |
Humana |
Use Member & Provider contact information on back of Member's ID card. |
MaineCare |
Use Member & Provider contact information on back of Member's ID card. MaineCare does not have their own Care Coordinators but can provide patient and family with list of resources. |
Maine Community Health Options |
Contact Laura Pelletier for Care Navigators. She can connect to Nurse Care Management as well if needed. 207-402-3750 |
Martin's Point |
Use Member & Provider contact information on back of Member's ID card. |