Before leaving Aetna in 2016, James D. Cross, MD was Vice President and head of National Medical Policy and Operations. In this role, he was responsible for Clinical Policy and Reimbursement/Payment Policy for the company and for many national clinical programs, including Disease Management, Women’s Health, Beginning Right, Infertility, National Medical Excellence, Informed Healthline and Healthy Lifestyle Coaching. He was also the head of operations for national Precertification, Clinical Claim Review, Clinical Appeals, External Review, and the Oral and Maxillofacial Surgery Unit, as well as the International Care Management Center in four overseas locations. This role involved managing roughly 2000 employees in the US and abroad. Jim’s background includes key leadership roles over the past 27 years with several private payer organizations including Travelers, MetraHealth, United Healthcare, and Prudential Healthcare (which was acquired by Aetna).
Jim received his M.D. degree from the University of Minnesota Medical School in Minneapolis and did a residency there in pediatrics. His background also includes 12 years practicing Emergency and General Medicine.
Diplomat of the American Board of Quality Assurance and Utilization Review Physicians (ABQAURP) for 30 years to September 2016
Fellow and former member of the Board of Trustees of the American College of Medical Quality (ACMQ) and is a Past President of the college
Former Member of the Board of Directors of the American Board of Medical Quality and served as its Secretary-Treasurer
Member of the Executive Leadership Council for the National Association of Managed Care Physicians (NAMCP)
Recently a member of the Board of Directors for the Population Health Alliance and served as its Secretary
Former member of the Board of Directors for The Physicians’ Foundation, as Aetna's representative
Has served on advisory council panels for several well known national corporations