Medical Director –
Physician Consulting

Self-insured health plans and their sponsors are often faced with making difficult medical necessity and determination decisions that significantly impact both the member and the health plan sponsor. CMSI’s clinically experienced medical directors are available as resource consultants to provide support and recommendations for

• Pre- and post-denial medical necessity decisions
• Guidance in areas of medical ambiguity
• Population health needs in relation to active medical community practices
• Medical plan changes or benefit positions
• Health vendor review and vetting
• Health and wellness education program development
• Stop Loss Medical Review

CMSI’s medical review nursing team is experienced in the extensive review of stop loss and high-dollar laser cases. Combining years of clinical expertise, along with access to gold standards of care, medical physician networks, actuaries, underwriters and data aggregators, we are able to provide high internal value medical reviews to insurance underwriters looking for competitive advantages during renewals or when concurrently managing health spends.