James Cruz, M.D.
Costa Mesa, CA
Dr. James Cruz is a data driven, transformative physician leader adept at evidence-based physician practice and hospital-physician collaborations which strengthen provider networks, improve access to care, and reduce total cost of care. He is an expert in initiating and executing creative solutions to improve utilization management, transitions of care, and provider network performance.
With nearly 10 years of senior executive healthcare experience, Dr. Cruz joined HMA from Molina Healthcare of California, a Medicaid and Medicaid-Medicare focused managed care organization that arranges for the delivery of healthcare services to low-income families and individuals who are eligible for government-sponsored programs in the state of California.
During his tenure at Molina, Dr. Cruz served as senior medical director, medical director and chief medical officer (CMO). He restructured Molina’s Quality Improvement Department, implemented a practice facilitation program in collaboration with key medical groups, augmented Molina’s pay-for-performance incentives, and supervised the reorganization of Healthcare Effectiveness Data and Information Set (HEDIS) data collection processes. He led a multidisciplinary team that developed and implemented performance improvement initiatives targeting dual eligible members, resulting in a 15 percent reduction in the total cost of care.
As medical director, Dr. Cruz collaborated with contracted medical groups to improve clinical processes to meet both quality and cost benchmarks for various product lines. He reviewed contracted medical group performance reports of ambulatory and inpatient utilization metrics and identified opportunities for improvement.
Prior to Molina Healthcare, Dr. Cruz served as associate vice president of Health Services and medical director at Arcadian Management Services, where he oversaw the quality improvement program, as well as all utilization management nursing functions, case management, and utilization data analysis. He developed and managed a $3 million departmental budget and was responsible for ambulatory and acute care authorization review, claims review, and review of provider appeal and grievances. He reviewed medical group performance reports and identified opportunities for focused improvement. He also collaborated with contracted medical groups to educate, modify, and recommend medial group adjustments and physician practice behavior.
Throughout his career, Dr. Cruz has helped young physicians for practice in California’s medically underserved communities. In 1992, he established California’s first family medicine residency program sponsored by a Federally Qualified Health Center (FQHC) in Fresno. He provided administrative and academic leadership for family medicine training programs in Sacramento and Pomona, California.
Dr. Cruz earned his medical degree from the University of California, San Diego School of Medicine. He completed his residency in family medicine and a fellowship in community medicine at White Memorial Medical Center in Los Angeles. He is board certified by the American Board of Family Medicine.