Our Executive Team
Decades of combined experience in independent medical review, occupational medicine, and claims operations.
Executive Team
Gary Ierna, DC
Chief Executive Officer / Founder
Founder & Chief Executive Officer, CMRS. Dr. Gary Ierna is Founder and Chief Executive Officer of CMRS, which he co-founded in 2024 with Chief Operating Officer Melissa Veen Starnes. He sets the company’s strategic direction and oversees executive leadership, quality assurance, and operations across utilization review, peer review, disability review, impairment rating review, and pharmacy review.
In addition to his insurance experience, Dr. Ierna built a clinical career focused on musculoskeletal pain disorders as a chiropractor, acupuncturist, and rehabilitation specialist. He is an author and international lecturer and has held faculty appointments at the University of Bridgeport and New York Chiropractic College. He co-owns the Corporate Wellness Center at Travelers in Hartford, Connecticut, where he retired from clinical practice in 2019.
Insurance Medicine Leadership. Dr. Ierna brings 25 years of peer and disability review experience, including 22 years in senior leadership. He began his insurance career in 2002 as Associate Medical Director at AIG/HealthDirect and later chaired the Medical Quality Improvement Committee at TRIAD Healthcare, where he led development of medical treatment guidelines that supported his 2012 appointment to the Advisory Committee of the Official Disability Guidelines. From 2008 to 2024, he served as the chiropractic consulting physician for Liberty Mutual and later Lincoln Financial Group’s disability division. In 2015, he became the Associate Medical Director at CareReview, where he built the provider network and oversaw quality assurance and URAC compliance. From 2016 through 2024, he also served as Director of Operations for Premier File Review, a peer review organization which supported IROs throughout the U.S. Across these roles, he developed the operational workflows, report standards, and quality frameworks that now shape CMRS.
Melissa Veen
Chief Operating Officer / Co-Founder
Co-Founder & Chief Operating Officer, CMRS. Melissa Veen is the Co-Founder and Chief Operating Officer of Comprehensive Medical Review Services (CMRS), which she co-founded in 2024 with CEO Dr. Gary Ierna. As COO she oversees CMRS’s day-to-day operations across utilization review, peer review, disability review, impairment rating review, and pharmacy review product lines, leading staffing, client implementation, URAC and state regulatory compliance, and the operational systems that protect turnaround and report quality. Melissa co-founded CMRS to bring the Independent Review Organization industry back to a higher standard: deep client relationships, constant communication, responsive customer service, and review production that is made, and stays in the USA.
Insurance Industry Experience. Melissa brings more than 25 years of senior IRO and IME operational leadership. From 2015 through 2024 she served as Executive Vice President of Operations at CareReview, a URAC-accredited Independent Review Organization, where she developed and oversaw every product line including utilization reviews, peer reviews, pharmacy reviews, disability reviews, and impairment rating reviews. She formulated and implemented a National PPD & Impairment Rating Review Program for major workers’ compensation carriers and TPAs, recruited and credentialed the physician reviewer panel, led URAC and state UR audits, and participated directly in sales, building client presentations and owning carrier, PBM, and TPA relationships. From 1998 through 2014 she served as Director of Operations at Churchill Medical, Inc., a Texas IME company, where she built and credentialed an IME network of more than 500 Texas physicians, trained them on the AMA Impairment Rating Guidelines, designed product launches and marketing, and oversaw regulatory compliance.
David Berube, MD, MPH, FACOEM
Chief Medical Officer
Chief Medical Officer and Medical Director, Health & Disability Review Services, CMRS. Board certified in Internal Medicine and Occupational & Environmental Medicine, Dr. Berube serves as Chief Medical Officer and Medical Director of Health & Disability Review Services at CMRS, where he provides enterprise-wide clinical leadership for the organization’s peer review physician network. He leads clinical strategy and quality standards across CMRS’s business areas, guides complex medical record reviews and functional analyses, and advances initiatives that improve medical quality, consistency, and efficiency.
In addition to his executive leadership role, he practices occupational medicine at Trinity Health of New England in Connecticut, is an assistant clinical professor at Yale University, and serves on the Board of Directors of the New England College of Occupational and Environmental Medicine.
Insurance Medicine Leadership. Dr. Berube brings decades of senior leadership experience in insurance medicine. He previously served as Chief Medical Officer for Lincoln Financial Group’s Workplace Solutions business, formerly Liberty Mutual Benefits, and as National Medical Director for Group Insurance at Aetna Life Insurance Company. Earlier in his career, he served as consulting Corporate Medical Director for Employee Health Services at both Travelers and Aetna. Across these roles, he partnered with treating providers, employers, claim leaders, underwriters, brokers, and legal teams to strengthen medical policy, support sound clinical determinations, and improve return-to-work outcomes. He is also a frequent educator and speaker on disability, absence management, and occupational medicine.
Paul Dwyer
Executive Director of Operations (CMRS)
Overview
Paul Dwyer serves as Executive Director of Operations at Comprehensive Medical Review Services (CMRS), joining the executive leadership team in July 2026. He oversees enterprise operations across CMRS's disability review, utilization review, peer review, impairment rating review, and pharmacy review service lines, leading operational strategy, production management, process improvement, workforce development, and client implementation. Paul works closely with executive leadership to ensure scalable operations, exceptional service, consistent report quality, and industry-leading turnaround performance as CMRS continues its national growth.
Insurance Industry Experience
Paul brings more than 25 years of senior leadership experience in disability insurance, absence management, and claims operations. Prior to joining CMRS, he held multiple executive leadership positions with Lincoln Financial Group's Workplace Solutions division, formerly Liberty Mutual Benefits, before retiring from the organization in 2024. Most recently, he served as Assistant Vice President of Major and Specialized Accounts, overseeing disability and leave operations for several of the company's largest national customers. Earlier leadership roles included Long-Term Disability Operations Manager, Manager of Life Claims, Leave Services and Accident & Health Operations, and Regional Operations Manager for Group Benefits Disability Claims. Throughout his career, Paul has led large multi-state operational teams, implemented enterprise process improvements, directed complex customer implementations, and partnered with executive leadership to improve operational performance, service quality, and customer satisfaction. His extensive operational expertise strengthens CMRS's commitment to delivering exceptional service and scalable solutions for carriers, TPAs, employers, and healthcare partners nationwide.
Medical Directors
Sankar Pemmaraju, DO, PM&R
Medical Director
Peer & Utilization Review Services
Medical Director, Peer & Utilization Review Services, CMRS. Board certified in Physical Medicine and Rehabilitation, Dr. Pemmaraju serves as Medical Director of Peer and Utilization Review Services at CMRS. In this role, he provides clinical leadership across peer and utilization review programs spanning workers’ compensation, disability, and auto/PIP services, setting high standards for reviewer quality and overseeing evidence-based determinations.
Alongside his executive leadership responsibilities, Dr. Pemmaraju maintains a clinical practice in the Dallas-Fort Worth metroplex, where he focuses on diagnosing and treating neuromusculoskeletal conditions with the goal of restoring function and improving quality of life.
Insurance Medicine Leadership. Dr. Pemmaraju brings more than 20 years of senior leadership experience in insurance medicine across IRO, carrier, TPA, and managed care environments. He currently serves as Medical Director for Texas at Broadspire and as Physician Advisor for Broadspire and MES Solutions. From 2021 to 2024, he also served as Medical Director for CareReview. From 2014 to 2016, he served as Chief Executive Officer of Premier Management and Review Solutions, LLC, a national peer review and IME organization. Earlier senior roles included Medical Director appointments at Omaha National Underwriters, PRIUM, and Promesa Health, as well as physician advisor appointments across more than a dozen IRO and carrier networks, including Genex, Dane Street, MRIoA, MCMC, and Aetna. Dr. Pemmaraju also previously served on the Texas Department of Insurance Designated Doctor List and has extensive experience performing impairment ratings, maximum medical improvement determinations, and return-to-work evaluations under Texas workers’ compensation regulations.
Robert Boolbol, MD, MBA
Medical Director
Pharmacy Review Services
Medical Director, Pharmacy Review Services, CMRS. Board-certified in anesthesiology with subspecialty certification in Pain Management, Dr. Boolbol serves as Medical Director of Pharmacy Review Services at CMRS. He provides clinical leadership for medication and pharmacy reviews and complex pharmacologic case analysis across workers’ compensation, disability, and auto/PIP lines of business. He also establishes clinical standards for reviewer quality and oversees opioid and complex regimen evaluations.
In addition to his executive leadership responsibilities, Dr. Boolbol is a managing partner and interventional pain medicine physician at Pain Management Partners, LLC, where he specializes in the diagnosis and treatment of chronic and acute pain disorders.
Insurance Medicine Leadership. Dr. Boolbol brings over two decades of experience as a senior operational leader in the independent review organization industry. Since 2016, he has served as Founder and Chief Executive Officer of Premier File Review, a national peer review provider network that has delivered more than 250,000 peer, utilization, and pharmacy review reports for IRO clients across workers’ compensation and disability lines. He leads recruitment, training, and compliance oversight, scaling production while maintaining clinical quality. From 2018 to 2023, he concurrently served as Medical Director for CareReview, where he provided physician oversight and quality assurance across utilization and peer review services. Formerly, he also worked as a healthcare strategy consultant with Booz Allen Hamilton, contributing to process redesign initiatives for one of the nation’s leading pharmacy benefit managers.
John Crouch, Ph.D., ABPP-CN
Medical Director
Mental & Behavioral Health Services
Medical Director, Mental & Behavioral Health Services, CMRS. Board-certified in Clinical Neuropsychology, Dr. Crouch serves as Medical Director of Mental and Behavioral Health Services at CMRS, where he provides clinical leadership for psychological, neuropsychological, and behavioral health and disability peer reviews and consultative services. He leads the mental health strategy in complex brain-behavior assessment, performance validity, and the defensibility of behavioral health determinations across disability, utilization, and peer review services, and brings extensive experience in brain injury rehabilitation.
In addition to his executive leadership role, he maintains a private practice in clinical neuropsychology in Connecticut and serves as a clinical instructor at the University of Connecticut School of Medicine. He is also a certified examiner for the Federal Aviation Administration, conducting both neuropsychological and psychological examinations.
Insurance Medicine Leadership. Dr. Crouch brings more than 30 years of experience applying clinical neuroscience within insurance medicine and disability review. He formerly served as Assistant Vice President and Medical Director for Lincoln Financial Group’s Workplace Solutions business, formerly Liberty Mutual Benefits, where he led behavioral health disability claims strategy across short- and long-term disability lines. In that role, he directed psychiatric and neuropsychological claim review and partnered with claim leaders, vendors, treating providers, and legal teams to promote consistent, well-supported behavioral health determinations. He has also served as a consulting reviewer for multiple disability and independent medical examination organizations.
Operations Leadership
Morgan King
VP - Peer Review Services
Vice President, Peer & Utilization Review Services, CMRS. Morgan King is the Vice President of Peer and Utilization Review Services at CMRS, where she leads strategy, operations, and client relationships across CMRS’s peer review, utilization review, and impairment rating product lines. She sets service standards, owns carrier and TPA relationships, and translates client feedback into operational improvements that elevate report quality, turnaround, and service delivery.
Insurance Industry Experience. Morgan joins CMRS from CareReview, where she served as the dedicated account manager for Liberty Mutual, Travelers, AmTrust, Employers, and CNA — bringing a rare combination of carrier-side insight and reviewer-side operational expertise. From 2016 through 2024 she served as Senior Account Manager at CareReview, managing utilization review, peer review, and impairment rating review accounts. Earlier, from 2013 through 2016, she served as Clinical Director at Churchill Evaluation Centers, where she recruited Texas physicians for state-mandated workers’ compensation evaluations, communicated with the Texas Department of Insurance Division of Workers’ Compensation, and oversaw quality control on medical reports. Morgan brings more than a decade of insurance industry experience built across both the carrier-facing and reviewer-facing sides of utilization and peer review.
Brianna Tokarczyk
Client Services Manager (CMRS)
Overview
Brianna Tokarczyk serves as a Client Services Manager at Comprehensive Medical Review Services (CMRS), where she is the primary point of contact for third-party administrators (TPAs), insurance carriers, and referral partners. Dedicated to exceptional customer service, Brianna focuses on building strong client relationships and ensuring a responsive, seamless experience at every stage of the review process. Drawing on her extensive background in the industry, she understands the needs and expectations of CMRS’s clients and brings valuable working experience with the reviewing provider network. She also coordinates closely with CMRS’s quality assurance team to make certain that every report meets the rigorous standards CMRS is known for. Her commitment to client satisfaction and quality helps deliver the reliability and defensibility that CMRS clients depend on.
Premier File Review Experience
Brianna joined CMRS in August 2025 from Premier File Review, where she served as Peer Review Coordinator from 2017 through 2025. At Premier she received and processed workers’ compensation files for physician review, organized and distributed case files to the reviewing physician panel, coordinated peer-to-peer consultations between physicians, monitored file progress to ensure timely report submission, and managed documentation across the firm’s internal systems. That day-to-day experience with reviewer coordination, case routing, and clinical workflow management brings the operational rigor CMRS clients rely on for predictable turnaround and clean case handoffs.
Matthew Pavelek, PA
Director of Quality Assurance
Director of Quality Assurance, CMRS. Matthew Pavelek is a Certified Physician Assistant with ten years of orthopedic and physical medicine practice experience and serves as the Director of Quality Assurance at Comprehensive Medical Review Services (CMRS), where he leads the QA team that underpins CMRS’s URAC-accredited quality standards. He oversees a QA team comprised primarily of physician assistants who review every report before it is submitted to the carrier, auditing for clinical accuracy, guideline citation, internal consistency, regulatory compliance, and clarity of rationale. This pre-submission review is the final checkpoint that protects report defensibility and ensures every file leaving CMRS meets a single, repeatable standard.
Quality Assurance Experience. Matt brings six years of dedicated QA experience from Premier File Review, where he served as Director of Quality Assurance from 2019 through 2025. At Premier, he built the pre-submission review processes that protected clinical accuracy, defensibility, and regulatory compliance across hundreds of thousands of peer review, utilization review, and pharmacy review reports for IRO and carrier clients. He developed and trained the physician assistant QA team, established standardized audit criteria across multiple report types, and worked directly with reviewing physicians to deliver feedback that elevated reviewer performance over time.
Heather Johnsen
Physician Recruiter
Physician Recruiter, CMRS. Heather Johnsen serves as Physician Recruiter at Comprehensive Medical Review Services (CMRS), where she is responsible for recruiting physicians for CMRS’s provider panel, credentialing physicians to URAC and client-specific standards, and maintaining the physician profiles and supporting documentation that keep CMRS’s reviewer network audit-ready across utilization review, peer review, disability review, impairment rating review, and pharmacy review product lines.
Provider Relations. Heather owns CMRS’s provider relations function, serving as the day-to-day point of contact for the reviewing physician panel. She manages reviewer onboarding, license and board-certification verification, ongoing re-credentialing cycles, and the documentation trail that supports CMRS’s URAC accreditation and state regulatory compliance. Her work sustains the depth, specialty coverage, and credentialing integrity of the network CMRS clients rely on for clinically defensible, on-time reports.