James Cross, MD is Aetna's Head of National Medical Policy and Operations. In this role, Dr. Cross oversees teams that develop and maintain clinical policy as well as reimbursement and coding methodology for the company. In addition, he is responsible for all national Aetna Health ConnectionsSM programs, including Disease Management, Precertification Operations, Women's Health, Beginning Right, Infertility, National Medical Excellence, Informed Helpline, Wellness, and Healthy Lifestyle Coaching, and for the Clinical Claim Review operation, the National Clinical Appeals Unit, External Review, and the Oral and Maxillofacial Surgery Unit as well as the International Care Management Center. Dr. Cross' background includes key leadership roles over the past 24 years with several private payer organizations, including Travelers, MetraHealth, United Healthcare, and Prudential Healthcare (now Aetna).
Dr. Cross 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 15 years practicing Emergency and General Medicine. Dr. Cross is a Diplomat of the American Board of Quality Assurance and Utilization Review Physicians (ABQAURP). He is a fellow and member of the Board of Trustees of the American College of Medical Quality (ACMQ) and its current President, and a member of the Board of Directors for The Physicians' Foundation and the Care Continuum Alliance.