Pediatric Care Coordination Resource Guide

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/case management occurs at the patient or family level and, as defined by the Case Management Society of America. It 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.

Regional Resources

RegionPoint Position Contact
Franklin County, MEFranklin Pediatrics
RN Care Coordinator
Lincoln County, MEPractice Manager
Family Medicine, Internal Medicine, Pediatrics 
Kennebec Pediatrics Social Worker 
Supervisor, CCT
Brunswick, ME

RN Clinical Manager, Mid Coast Pediatrics
Fax: 207-798-4618
Care Coordinator
CHANS Home Health
Rockport, MEPen Bay Pediatrics
RN Care Coordinator
St. Mary's

Nurse Care Manager
CCS Pediatrics
Social Worker, Women’s Health Associates, Family Birthing Unit, and Pediatrics
Practice Manager
Waldo CountyCare Coordinator
Norway, MEWestern Maine Pediatrics 
Care Coordinator
Southern Maine
Fax: 207-761-3078 

Contact Information

PayerContact Information to Determine Access and/or Make Referral
AetnaFor HMO-based plans and all Medicare Advantage plans: call 800-624-0756 
For Indemnity and PPO-based plans: Call 888-MDAetna (888-632-3862)
AnthemCall Provider Services at 800-676-2583
CignaCall Provider Services at 800-926-2273
Harvard PilgrimCall 866-750-2068 to refer a member. Please leave the member full name, date of birth, HP insurance number, phone and brief reason for the referral. 
HumanaUse Member & Provider contact information on back of Member's ID card.
MaineCareUse 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 OptionsCall 207-402-3750
Martin's Point Health CareUse Member & Provider contact information on back of Member's ID card.