Mark Gerges, MD
Nurse Consultant
Mark Gerges, MD is an executive healthcare consultant with extensive experience in behavioral
health and substance use disorder treatment. His consulting work spans clinical oversight, operational
leadership, and payer strategy, supporting healthcare organizations in regulatory compliance,
utilization management, and sustainable, audit-ready operations.
Dr. Gerges has held senior executive and medical leadership roles overseeing medical services,
utilization review, compliance, credentialing, payer relations, and revenue cycle performance. He has
led organizations through multiple successful Joint Commission surveys and commercial and
government payer audits. His experience includes direct consulting with Special Investigations Units
(SIU) for a major payer organization, supporting fraud, waste, and abuse reviews and corrective action
planning.
A core focus of Dr. Gerges’ consulting practice is aligning clinical decision-making, medical necessity,
and documentation with payer and regulatory requirements. He works closely with clinical and
operational teams to improve utilization management processes, strengthen appeal strategies, and
support defensible, consistent determinations of care.
In addition to clinical consulting, Dr. Gerges provides operational advisory services related to payer
contracting, financial performance, and enterprise operations. He has negotiated and maintained
contracts with large national and regional commercial insurance carriers and advised leadership
teams on payer strategy, value-based care models, and operational alignment across levels of care.
Dr. Gerges has served in executive, interim, and consulting roles across multi-site behavioral health
systems, inpatient and residential programs, and specialty healthcare organizations. He has authored
and co-authored industry publications and presented nationally on healthcare compliance, utilization
management, and treatment strategies.