Pittsburgh, PA

Senior Medical Director, Highmark, Inc.

Represented: Payers
Term ended August 2022

Thomas James, III, MD, is senior medical director in the Office of the CMO at Highmark, Inc. In this capacity he provides the clinical oversight to Highmark’s quality and related programs. He maintains his connections with national physician societies and provider organizations for greater alignment of goals for the coordination of care for Highmark’s membership in Pennsylvania, Delaware, and West Virginia.

Prior to joining Highmark, Inc., James has served as senior medical director for such organizations as Baptist Health in Kentucky, AmeriHealth Caritas, Humana, Anthem, Traveler’s Health Network, Sentara, and HealthAmerica. He has gained experience with commercial, Medicare, and Medicaid health plans through his career.

He has been active on many volunteer boards in the arts (e.g., Pittsburgh Opera Board, Kentucky Opera Board, Louisville Visual Arts Association), medical service (e.g., Laughlin Children's Center in Sewickley, Project Sunshine in New York, Partners for a Healthy Louisville), and medical policy in Washington (e.g., National Quality Forum, National Committee for Quality Assurance, AAAHC, Picker Institute, and MED CAC).

James is board certified in internal medicine and pediatrics. He received his medical degree from the University of Kentucky and served his residencies at Temple University Hospital, Pennsylvania Hospital, and Children’s Hospital of Philadelphia. He maintains a limited clinical practice in Wexford, Pennsylvania.

James served on the Advisory Panel on Healthcare Delivery and Disparities Research from August 2019 to August 2022.

Conflicts of Interest

As of March 18, 2019

  • Highmark, Inc., Employer
  • Allegheny Health Network, Integrated Delivery and Financing System, Western Pennsylvania, Delaware, and West Virginia, Employer
  • Laughlin Children’s Center, Pittsburgh, Board Member
  • National Quality Forum, Workgroup Member
  • National Committee on Quality Assurance, Workgroup Member
  • Accreditation Association of Ambulatory Health Care, Workgroup Member
  • American Journal of Managed Care, Reviewer


Person Type
Panel / Committee