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 SRichard@fchn.org
207-778-0482
LCHC Practice Manager
Family Medicine, Internal Medicine, Pediatrics
Sarah Harper sarah.harper@lchcare.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 sswan@midcoasthealth.com
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 sbloy@midcoasthealth.com
Pen Bay PenBay Pediatrics RN Care Coordinator Jessica Bowen jbowen1@pbmc.org
207-921-5635
SMHC Central Navigation

ctiliaison@mmc.org
207-482-7089
Fax: 207-761-3078

St. Mary's

Nurse Care Manager, CCS Pediatrics Sarah Ranger, RN ranges@mmc.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 shall@wcgh.org
207-930-6762 x4797
WMH Western Maine Pediatrics Care Coordinator Nina Douglas ndouglas1@wmhcc.org
207-743-8766
MMC/MMP Central Navigation

ctiliaison@mmc.org
207-482-7089
Fax: 207-761-3078 

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

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.