About Us

Biography - Frank P. James, MD, JD, FASAM, FACLM

JamesFrank-wwwDr. James earned a Bachelor of Arts in Premedical Studies and Japanese Language from the University of Notre Dame.  He earned his Law and Medical Degrees at Southern Illinois University.  Dr. James is a member of both the Ohio and Illinois Bar.  He is a Veteran of the United States Army, having completed Residency in General Psychiatry at Walther Reed Army Medical Center, and Fellowships in Child and Adolescent Psychiatry at The Children’s Hospital of Philadelphia and Forensic Psychiatry at the University of Cincinnati School of Medicine.  He is Board Certified in General, Child and Adolescent and Forensic Psychiatry as well as Addiction Medicine.  He maintains 11 active state medical licenses.

Dr. James spent his clinical years providing inpatient and outpatient psychiatric services in underserved areas in the Ohio Valley.  He developed specialty clinics in ADHD, Bipolar Disorder and Schizophrenia, and developed an Opioid Use Disorder (OUD) outpatient clinic focused on the integration of group therapy, psychotropic medication management, and Medication Assisted Treatment (MAT).

Dr. James joined the Optum organization in July 2011.  Over the last 5 years, he has served as a national Subject Matter Expert (SME) on Substance Use Disorders (SUDs) treatment, with a particular focus on Opioid Use Disorder.  He has been involved with SUDs benefit determination guideline development, including those specific to Urine Drugs Tests (UDT).  He serves as Optum’s SME in the development of UDT policy for United HealthCare.  He also consults with Optum Rx on matters pertaining to Prior Authorization for all types of MAT. 

Dr. James has been a Designated Medical Director for Harvard Pilgrim Health Care from 2011 to 2017.   He has been an integral part of utilization management creating nation templates for medical benefit review.  He has extensive experience with multiple benefit platforms for both commercial and public sector medical benefit review.  Currently, he is a Behavioral Medical Director for Case Management with focus on medical and behavioral integration regarding Child & Adolescent and Substance Use Disorder complex case management and super utilizers.

As an educator, Dr. James developed several learning modules on Optum Learn Source regarding benefit determinations and continued education on SUDs, MAT, and specifically on Methadone Treatment.  He is one of several SME’s that run the Substance Use Grand rounds held on a weekly basis.  He has authored two TIPS for continued education of Medical Directors and CAs on Opioid Use Disorder.  He continues to do national MD and Care Advocate (CA) training on via Lunch and Learn presentations on SUDs treatment and benefit determination.  In addition to serving as a SME for Optum Commercial business, Dr. James also assists with Optum Public Sector business in matters related to challenges with SUDs benefit coverage and governmental affairs.  He routinely provides MD and Care Advocate with required new-hire training in American Society of Addiction Medicine (ASAM) criteria used for benefit determinations.  As a licensed physician in Texas, he also trains new hires in the Texas State specific SUDs benefited determination guidelines.

Dr. James has represented Optum and United HealthCare in Congressional Session on Opiate Use Disorder, Delta Airlines on Men’s Health, and forward facing representation for Optum in RFPs and Customer Education.  He has been involved in new applications for member and provider engagement technology with both Optum Labs and Optum Venture Capital. 

Dr. James is involved nationally with ongoing SUDs treatment policy and treatment development.  He is a member of the American Society of Addiction Medicine (ASAM) Finance Committee, Legislative Action Committee and Public Policy/Legislative Strategy Committee.  He is the Vice Chair of the ASAM Payer Relations Committee and Alternate to ASAM’s Board of Directors for Region III.  He helped develop ASAM’s Public Policy on Hepatitis C treatment, including recommendations for integrating Hepatitis C treatment in SUDs treatment programs, as well as looking at alternative payment models.

Disclosure of Interests and Affiliations