Overview
Work History
Education
Skills
Timeline
Generic

Rina S DeCarvalho

Farmington,CT

Overview

4
4
years of professional experience

Work History

Healthcare Economics Consultant

Optum
02.2023 - Current
  • Build opportunity analysis to quantify potential market savings through well-managed MCG benchmarks comparison, creating ED, IP and SNF profile, as well as Outpatient evaluation
  • Developed and maintained affordability forecasts as part of the forecast cycle, facilitating program design, implementing standardized processes for estimating program value, and contributing to ongoing updates
  • Partnered with national program leads to ensure valuation models accounted for market nuances
  • Supporting the region in achieving affordability savings targets by partnering with market leaders, Clinical Performance, HCE, and Actuarial teammates
  • Maintaining frequent touch points with CDO stakeholders, assuming the role of project manager for the market to ensure projects are properly scoped, prioritized, planned, and executed
  • Monitor data quality and integrity, leading issue resolution in partnership with OCUDS, market, OCSP team, vendors, and payers
  • Maintain the Northeast region data deck with periodic updates and delivered ad-hoc analytics in order of priority.

Senior Healthcare Economics Analyst

Optum
09.2021 - 02.2023
  • Converted complex SQL scripts and tables from MSSQL to Snowflake and created a helpful conversion guide for the team
  • Estimated YTD Forecast and Affordability savings and produce year-end projections for OC CT, as well as supported baseline and target setting exercise for 2023
  • Delivered accurate monthly affordability utilization metrics against targets, through Tableau dashboards created to review results on performance with CDO stakeholders
  • Maintained Provider Roster to support accurate monthly reporting
  • Developed and executed a coaching and transition plan for a new employee to take over regulatory, UM, and CM reporting, ensuring a smooth transition during parental leave
  • Monitored data integrity of OCN-CT data in OCUDL and OCUDM, providing support to resolve issues and navigating changes as operations moved to the OC strategic platform.

Associate Healthcare Economics Analyst

Optum
06.2020 - 09.2021
  • Supported regulatory, UM, and CM reporting for OCN-CT global risk members in a timely manner
  • Developed technical skills to create reports in Allscripts Report Builder and supported ad hoc CM reports for OCN-CT
  • Completed the Authorization Report, which provides essential data for building inpatient utilization metrics, as well as produce the SNF Summary, tracking performance and utilization of OCNCT contracted SNFs, and the Commercial KPI Summary, a high-level utilization tracker for monitoring Commercial ACO populations, with accuracy and punctuality.

Education

Master of Healthcare Informatics -

Purdue University Global
02.2025

Bachelor of Arts in Mathematics with a Specialization in Actuarial Science -

Central Connecticut State University
05.2020

Skills

  • Healthcare Economics
  • Opportunity analysis
  • Market savings
  • MCG benchmarks comparison
  • Forecasting
  • Program design
  • Valuation models
  • Affordability savings
  • Data quality and integrity
  • Analytics
  • SQL
  • Tableau
  • Reporting
  • Allscripts Report Builder
  • Utilization metrics

Timeline

Healthcare Economics Consultant

Optum
02.2023 - Current

Senior Healthcare Economics Analyst

Optum
09.2021 - 02.2023

Associate Healthcare Economics Analyst

Optum
06.2020 - 09.2021

Master of Healthcare Informatics -

Purdue University Global

Bachelor of Arts in Mathematics with a Specialization in Actuarial Science -

Central Connecticut State University

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Rina S DeCarvalho