Nurse Advocates & Medical Management
 

 

Programs Overview

The Medical Management/Disease Management Programs are administered by “YourChoice” Nurse Advocates and are designed to assist members in managing their health and improving quality of life.

Nurse Advocate Services
  • Coordinates pre-certification of hospital stays and other medical related services
  • Assist members with navigating through the health care maze
  • Provides information to support health care decisions
  • Aides in the health care specialty referral process and coordination of care
  • Onsite visits with members to their providers for health care services
 
Medical Management Programs
  • Weight Loss Surgery
  • Pain Management
  • Sleep Disorders
  • Cardiac Health for Life
  • Healthy Pregnancy

Nurse Advocates

For more information on the above programs, pre-certification, or physician referral contact a Nurse Advocate at 941-748-4501

Meredith Zinn, RN        x6409        This e-mail address is being protected from spambots. You need JavaScript enabled to view it
Barbara Willey, RN       x6407        This e-mail address is being protected from spambots. You need JavaScript enabled to view it
Robyn Golabek, RN      x6411        This e-mail address is being protected from spambots. You need JavaScript enabled to view it

 

Meet your Nurse Advocates


Meredith Zinn

Nurse Advocate Manager

Meredith has been with the county since 2003 as a Member Advocate. She has many years of experience in the insurance industry as an RN. She manages the Pain Program and the Sleep Disorder Program within the County. She was promoted to Advocate Manager last year after long-time friend and co-worker Charmaine retired. Meredith moved here 19 years ago and lives locally with her husband and enjoys swimming, scuba diving and reading.

 
Barbara Willey

Nurse Advocate

Barbara is responsible for assisting members with their healthcare needs and provides with pre-certification, as well as a wide variety of health insurance tasks. She has also assumed responsibility for the Surgical Weight Loss Program. Barbara is from Philadelphia, Pennsylvania. She brings to ManateeYourChoice over thirty years of nursing experience and a passion for helping people, through education, to live a healthy lifestyle. A permanent resident of Florida since 2004, she lives here with her husband John.

 
Robyn Golabek

Nurse Advocate

Robyn is a Registered Nurse with over 25 years of nursing experience that includes a passion for promoting wellness and healthy living.  She is the Cardiac Nurse Advocate and the Healthy Baby Nurse Advocate for the Manatee YourChoice Health Plan.  Robyn and her husband have been Bradenton residents since 1987 and enjoy gardening, biking, walking and exploring the beautiful parks of Florida.

 

Weight Loss Surgery

Nurse Advocates, (941) 748-4501 x6407

Gastrointestinal surgery for obesity promotes weight loss by closing off part of the stomach to make it smaller.  This works by reducing gastric volume, slowing gastric emptying and creating an early satiety.  Manatee YourChoice Health Plan covers the Roux-en-Y Gastric Bypass (RYGB) and the Laparoscopic Adjustable Gastric Banding (LAGB or LAP-BAND®) surgical weight loss procedure.  Call the Nurse Advocates to learn more.


Qualifying Criteria:
  • You must have a Body Mass Index (BMI) of 40 or greater, or 100lbs over ideal body weight. 
  • A  Body Mass Index (BMI) of 35 – 39 with other complicating factors; may be considered.

Pre-Operative Process:
  • Contact the Member Advocacy Program to discuss eligibility & requirements 

Weight Loss Surgery Benefit:

The plan benefit pays according to your level of benefit (Basic, Better, Best or Ultimate) at the time of service.  The Member is responsible for any and all deductible and co-insurance according to the level of benefit (Basic, Better, Best or Ultimate) at the time of service.

*Refer to the current Benefit Guide regarding benefit details.

 

Chronic Pain Management

Nurse Advocates, 748-4501 x6409

The goals of this program are to optimize the function and lessen limitations of people who suffer from chronic pain, and to receive the most appropriate type of care to reduce chronic pain.  Chronic pain is defined as pain that lasts for over 3 month’s duration. Members who participate in this program see physicians who specialize in Chronic Pain treatment and Lifestyle Coaches to learn coping skills.  Call the Nurse Advocates to learn more.

Injections of medication into the spine, or muscle groups may be required to reduce pain and or edema. 

  • Pre-certification/prior approval is required for ALL pain management injections and invasive procedures.
  • Failure to obtain approval could result in denial of payment for services.
  • Physicians who specialize in pain management are required to perform these procedures.
  • Consultation with a network LAMP Provider may be required for patients with chronic pain. 
  • Quantity limitations apply to selected pain medications as established by the Manatee YourChoice Health Plan and our pharmacy benefit manager.
  • Patients with chronic pain and a BMI of 30 or more may be required to have an evaluation by a network dietician for dietary evaluation and/or modification prior to or during the treatment of pain management procedures and/or medication exceeding quantity limitations.
  • An exercise plan needs to be addressed by the treating physician. 

Chronic Pain Management Benefit:

The plan benefit pays according to your level of benefit (Basic, Better, Best or Ultimate) at the time of service.  The Member is responsible for any and all deductible and co-insurance according to the level of benefit (Basic, Better, Best or Ultimate) at the time of service.

*Refer to the current Benefit Guide regarding benefit details.

 

Sleep Disorder (Sleep Apnea) Program

Nurse Advocates, (941) 748-4501 x6409

Sleep Apnea is the temporary cessation of breathing during sleep and or airway obstruction. The purpose of this program is to educate the member as to causes of sleep apnea, and to provide guidance to the member regarding the plan benefit and the importance of using participating providers. 

  • All sleep studies REQUIRE Pre-certification by a YourChoice Nurse Advocate.
  • A physician who specializes in Sleep Disorders (Diplomat of the American Board of Sleep Medicine) will supervise and interpret all Sleep Studies.
  • Pre-test evaluation by a Physician who is a Diplomat of the American Board of Sleep Medicine is required when a sleep study is recommended by the primary care physician.

Medical Equipment utilized for Sleep Apnea

If equipment is needed and ordered by the appropriate physician, the equipment must be pre-certified by a Nurse Advocate and be issued through a network provider.

The equipment is rented initially for approximately 90 days.  A Nurse Advocate will call you monthly for the first 3 months to assist with issues that may arise while adjusting to the equipment.  We want you to be satisfied with the equipment and the treatment plan set forth by your physician.


Sleep Disorder Benefit:*

The Plan covers consultation and diagnostic testing for sleep apnea, a temporary cessation of breathing during sleep and or airway obstruction.

  • An In-Network Provider MUST provide these services.  No benefit will be paid to an Out of Network provider
The plan benefit pays according to your level of benefit (Basic, Better, Best or Ultimate) at the time of service.  The Member is responsible for any and all deductible and co-insurance according to the level of benefit (Basic, Better, Best or Ultimate) at the time of service.  

*Refer to the current Benefit Guide regarding benefit details. 


For more information on Sleep Apnea select the items below:

  Sleep Apnea Information Sheet
  Sleep Apnea Q & A

 

Healthy Pregnancy Program

Wellness/Fitness Advocate, (941) 748-4501 x6464

The Health Pregnancy Program provides a variety of educational materials to all pregnant moms. The goals of this program are to reduce risks which may cause an early birth and to prevent unexpected complications during the pregnancy.  Information included in the packet: Importance of prenatal vitamins, good nutrition, exercise, travel tips, smoking, and much more.  Call the Wellness Advocate to learn more.


You may be eligible for:

Reimbursement of 75% of the cost of attended Prepared Childbirth Classes for all pregnancies with submitted proof of attendance and receipt of payment.

Yweight HealthBucks Pregnant Members are eligible to receive the maximum reward (according to their pre-pregnancy reward level) in Yweight Health Bucks for staying within their physician prescribed Healthy Weight Range and completing the following program rquirements:  

  • Meet with a Network Registered Dietician at least one time during the 1st or 2nd trimester.
  • Complete an Exercise Consultation one time per trimester with Fitness Advocate, 748-4501 x6464.
  • Must meet your expected healthy weight range goal as prescribed by your physician.


Click on Healthy Pregnancy Program Form for details

 


Cardiac Health for Life Program

Nurse Advocates, (941) 748-4501 x6411

This is an individualized program to help the member obtain and retain a healthy cardiac lifestyle.  This program may be initiated by the member, the Cardiac Coach with the member’s agreement or a physician with the member’s agreement. The purpose of the program is to help a member in his/her commitment to reduce cardiovascular disease and improve quality of life through education and one-on-one coaching/interaction.

HealthBucks of $144.00 may be earned after 12 months of enrollment in the program and by completing the Cardiac Health for Life Program Commitments - see below form for details.

Click on Cardiac Health for Life for program details and healthbucks information.

 

 

 
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