Medical Director Services

Overview

CMRS Medical Director Services provide insurance carriers, TPAs, managed care organizations, and employers with structured, ongoing clinical expertise – not transactional one-off referrals. Our medical directors and specialty physicians embed with your team to provide real-time guidance on complex and high-risk claims, coverage policy review, program-level strategy, and oversight of your internal clinical staff.

Who It’s For

• Insurance carriers seeking ongoing clinical advisory support
• TPAs managing complex claim portfolios
• Managed Care Organizations needing specialty physician oversight
• Self-insured employers with in-house claims teams
• Aviation, transportation, and safety-sensitive operators

What’s Included

• Virtual Claim Consult Forums: Regularly scheduled case-based discussions between CMRS physicians and your claims team – proactive, not reactive.
• Real-time clinical guidance: On-demand advisory on complex or high-risk claims before errors compound.
• Coverage policy review: Clinical input on policy language, utilization criteria, and medical policy development.
• Program-level consultation: Strategic input on claim volume trends, provider network optimization, and clinical quality benchmarks.
• Oversight of internal clinical staff: LCSWs, care managers, and nurse reviewers within your organization.
• Educational presentations: For claims examiners, adjusters, HR managers, and front-line supervisors.
• Case escalation: A direct line for your team’s hardest questions.
• Regulatory Compliance: A CMRS Medical Director can serve as your named signing physician for state regulatory filings.

Specialty Coverage

CMRS Medical Directors and specialty advisors span multiple disciplines. Key leadership:

• David Berube, MD, MPH, FACOEM – Chief Medical Officer, Health and Disability Management
• Sankar Pemmaraju, DO, PM&R – Peer & Utilization Review Services
• Robert Boolbol, MD, MBA – Medical Director, Pharmacy Review Services
• John Crouch, PhD, ABPP – Mental & Behavioral Health Services

Beyond our named leadership, CMRS draws from a deep bench of physicians who have previously served as Medical Directors at insurance carriers, third-party administrators, managed care organizations, and self-insured employer programs. That operational experience – sitting on the carrier side of the table, building utilization criteria, navigating regulatory requirements, and partnering with claims, underwriting, and HR leadership – is something we share directly with the companies we serve. Our medical directors don’t just bring clinical credentials; they bring practical experience running the kinds of programs our clients are operating today.

Engagement Models

We structure Medical Director engagements to fit the size, complexity, and frequency of your needs – from episodic consultative access to embedded, on-call relationships. Contact us to discuss which model fits your program.