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
Region | Point Position | Contact | |
---|---|---|---|
Franklin County, ME | Pediatrics RN Care Coordinator | sandy.richard@mainehealth.org 207-778-0482 | |
Lincoln County, ME | Practice Manager Family Medicine, Internal Medicine, Pediatrics | sarah.harper@mainehealth.org 207-563-4746 | |
MaineGeneral | Kennebec Pediatrics Social Worker | lynn.jackson@mainegeneral.org 207-626-6311 | |
Supervisor, CCT | jessica.nalesnik@mainegeneral.org | ||
Brunswick, ME | RN Clinical Manager, Pediatrics | shanna.swan@mainehealth.org 207-721-8333 Fax: 207-798-4618 | |
Care Coordinator | jking@midcoasthealth.com | ||
MaineHealth CHANS Home Health & Hospice | sarah.bloy@mainehealth.org | ||
Rockport, ME | Pediatrics RN Care Coordinator | jessica.bowen@mainehealth.org 207-301-5635 | |
St. Mary's | Nurse Care Manager CCS Pediatrics | sarah.ranger@mainehealth.org | |
Social Worker, Women’s Health Associates, Family Birthing Unit, and Pediatrics | bmerrill@stmarysmaine.com | ||
Practice Manager | kgelinas@stmarysmaine.com | ||
Waldo County | Care Coordinator | stacey.hall@mainehealth.org 207-505-4797 | |
Norway, ME | Pediatrics Care Coordinator | nina.douglas@mainehealth.org sheila.seamans@mainehealth.org 207-743-8766 | |
Southern Maine | 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 For Indemnity and PPO-based plans: Call 888-MDAetna (888-632-3862) |
Anthem | Call Provider Services at 800-676-2583 |
Cigna | Call Provider Services at 800-926-2273 |
Harvard Pilgrim | Call 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. |
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 | Call 207-402-3750 |
Martin's Point Health Care | Use Member & Provider contact information on back of Member's ID card. |