Experienced Professional Management Teams
A “how-to” guide on building the right group to help you lead.
By Michael Schmanske with Michael Hufford, PhD
TAKEAWAY: There is a tension between wanting to do everything and spreading oneself too thin. At some point it is time to delegate—but you’ll need a good team.
Choosing the Right Tool for the Job at the Right Time
As a newly created corporate entity, startups must perform a number of detailed administrative, executive and regulatory tasks. Teams of dedicated workers are the muscle of the startup, but executive responsibilities require direct responsibility to fall to a named individual for both practical and legal purposes. No matter how good your production team, you will need to select and hire fellow executives with whom to share your authority.
There are any number of ways to group and assign responsibilities. If possible, delineate the roles under clear lines of authority and reporting responsibilities. You are likely familiar with the big five “C-level” positions but there are any number of differentiated management titles that are often used as standard responsibility templates:
We’ll keep it simple by describing which roles to prioritize, when do you need them and how much should you be spending or sharing. Of course it depends on the specific needs of your company but there are some common guidelines to follow.
“If there was anything that neither one of us knew how to do, Steve would do it. He’d just find a way to do it.”
~Steve Wozniak, Co-founder of Apple
“Great things in business are never done by one person. They’re done by a team of people.”
~Steve Jobs, the other Co-founder of Apple
Stage One: First Steps in the Wild
In the early days of a startup, you are a jack-of-all-trades—CEO, head of product, recruiter, customer support, legal consultant and, often, the office manager too. It’s an exhilarating time, full of possibilities, but also full of landmines. The instinct to keep everything under your control makes sense: You’re the one who understands the vision, the urgency and the trade-offs required to move forward. But if you try to do it all for too long, your startup won’t grow—it will stall, and eventually it will collapse under the weight of your own bandwidth.
The First Crucial Hires (in order of priority)
The reality is that your job as a founder is to scale yourself first—not just the company. The first few hires you bring in will define your company’s trajectory, its culture and whether it successfully reaches the next stage. Some roles are mission-critical from day one, while others come into play as the business gains traction. The following guide is built from the ground up—who you need first, why and how to think about bringing them on. The key isn’t just filling roles—it’s finding people who extend your capabilities in ways that allow you to focus on what only you can do.
1. Chief Executive Officer (CEO) – YOU (For Now)
- What They Do: The CEO defines the company’s vision, fundraising strategy, and external relationships while making the highest-stakes decisions on where to allocate resources. In the early stage, this means everything from pitching investors to refining product-market fit to hiring your first team.
- Why It Matters: As the founder, you are the CEO until you either outgrow the role or choose to step aside for a more experienced leader. Your job isn’t to run every part of the company but to ensure the company survives long enough to become something worth running.
- What to Look for in Yourself (or Your Co-founder): Early-stage CEOs need resilience, storytelling skills (for investors and recruits) and a high tolerance for ambiguity. You will spend more time selling your vision than building product, so the ability to persuade, adapt and endure is critical.
2. Chief Scientific Officer (CSO) or Chief Medical Officer (CMO) – The Research & Clinical Lead
- What They Do: Lead the scientific, clinical and technical foundation of the company. They secure R&D credibility, regulatory feasibility and early clinical partnerships. A CSO is typically focused on lab-based biotech, while a CMO is more focused on clinical trial design and execution.
- Why It Matters: In healthcare, credibility is everything. Investors, regulators and even prospective team members need to see strong scientific leadership to take your startup seriously. Without it, the company is just an idea rather than a legitimate healthcare innovation.
- What to Look for: A recognized expert with domain knowledge and industry connections. They should be able to speak fluently to investors and potential partners without excessive jargon, all while driving research forward. Ideally, they bridge academia and industry—comfortable in both scientific rigor and commercial realities.
3. Chief Operating Officer (COO) – The Execution Backbone
- What They Do: Turns the chaos of early-stage operations into something functional. The COO builds processes, manages execution and ensures the company’s operational logistics don’t become bottlenecks.
- Why It Matters: In an industry where regulatory hurdles, clinical trials, and long development cycles exist, you need someone who turns strategy into day-to-day reality. Founders who try to “figure it out later” end up drowning in inefficiencies and missed milestones.
- What to Look for: A problem-solver with extreme adaptability. Early-stage COOs aren’t corporate managers; they’re hands-on executors who don’t mind getting in the weeds. A healthcare operations background is a plus, but adaptability is more important.
4. Head of Regulatory Affairs – The Compliance Architect
- What They Do: Defines and executes the regulatory strategy, ensuring the startup meets FDA, ICH, and payer approval pathways without fatal mistakes.
- Why It Matters: No regulatory plan = no product. In biotech, medtech, and digital health, regulations dictate everything from clinical trials to product design. Missteps can in the best case delay approvals, and in the worst case kill the company.
- What to Look for: Someone with experience navigating regulatory pathways specific to your product type. They don’t need to be full-time immediately, but they must be involved early.
5. Chief Technology Officer (CTO) – If Your Product Is Tech-Driven
- What They Do: Develop the core technology, whether it’s AI-driven diagnostics, patient-facing software or a bioinformatics platform.
- Why It Matters: If your startup is built on proprietary technology, you need a technical lead who builds the product in a scalable way.
- What to Look for: A technical founder or early-stage engineer with expertise in healthcare-specific software, AI or bioinformatics. If you’re outsourcing tech development early on, ensure you transition to an in-house lead quickly.
6. Head of Business Development / Chief Commercial Officer (CCO)
- What They Do: Build early partnerships, licensing agreements and potential commercial pathways. This person focuses on aligning business strategy with scientific/clinical development.
- Why It Matters: Many healthcare startups fail not because of bad science, but because they never find the right commercial pathway.
- What to Look for: Deep industry relationships and strategic vision—especially someone who understands healthcare reimbursement models, partnerships and payer engagement.
7. Chief Financial Officer (CFO) – If Fundraising Requires Complex Capital Strategy
- What They Do: Manage cash flow, investor relations and financial strategy.
- Why It Matters: If you’re raising significant capital, the CFO ensures the company is structured to attract and manage that investment.
- What to Look for: Not necessarily an early hire unless financial modeling, complex equity structures or revenue planning require specialized knowledge.
Later But Important: Specialized Hires
- VP of Market Access & Reimbursement—for payer strategy in insurance-heavy markets
- VP of Clinical Trials—if running early-stage human trials
- Chief People Officer (CPO)—when the team grows beyond ~30 employees
- Chief Marketing Officer (CMO)—when go-to-market strategies become crucial
Extra Options
Healthcare is complicated. That is why success is so highly rewarded. But it also means not every startup or business strategy will fit a cookie-cutter model. Instead, approach corporate team building as a variety of parts which you as the founder must select and assemble. If you discover your startup has a particularly complicated hurdle to overcome, the best solution may be to hire an expert. Some specialty roles which are often not filled until a company reaches maturity but which may be needed earlier depending on your specific situation:
- Chief Legal Officer (CLO) / General Counsel (GC) – Manages intellectual property, regulatory compliance, corporate governance, and contracts, especially crucial for startups dealing with FDA, HIPAA, or biotech IP protections.
- Chief Commercial Officer (CCO) / Chief Business Officer (CBO) – Develops early-stage partnerships, licensing deals, and commercialization strategies, particularly important for biotech and medtech startups.
- Chief Technology Officer (CTO) / VP of Engineering – If the company is AI-driven, software-based, or requires proprietary tech, the CTO leads development and innovation from the outset.
Specialized Roles
- Head of Regulatory Affairs (VP/Director level at this stage) – Ensures the company is meeting FDA, CMS, or clinical trial guidelines—often reporting to legal or scientific leadership.
- Head of Product (For AI/Health Tech) – If building software-driven healthcare solutions, this leader aligns technical development with clinical usability.
Hiring in a startup isn’t about filling positions—it’s about solving problems. If a role isn’t a bottleneck yet, don’t force the hire. But if you find yourself constantly stuck on the same problem, it’s time to bring in an expert. The best early hires are force multipliers—people who allow you to move twice as fast with half the stress.
Stage Two: Scaling & Preparing for Commercialization
At this point, the company must transition from R&D to structured execution, requiring leaders who can manage finances, clinical trials, regulatory approvals, and technical scaling. Since business requirements begin to diverge more distinctly after startup summaries are provided instead of deep dives. Also, roles duplicated from earlier represent additional responsibilities or heightened priority as a need.
Old Dogs, New Tricks
When you first hired a CFO the role may have been little more than accounting and payroll. As your company grows, so do the responsibilities of your executives.
- Chief Financial Officer (CFO) – Manages funding rounds, financial planning, investor relations, and revenue modeling (especially relevant for reimbursement-based healthcare models). At this point the job begins to transition from accounting to a role much more like investment banking.
- Chief Regulatory & Compliance Officer (CRCO) – Takes over regulatory strategy, focusing on clinical trials, FDA submissions, and international market approvals. Increased direct interaction and negotiation with both regulators and industry means communication skills and networks become much more relevant.
- Chief Clinical Development Officer (CCDO) – Directs clinical trials, investigator relationships, and patient recruitment, ensuring that products reach the right evidence thresholds. During the planning stage the CCDO position, like the CRCO, was likely viewed as a secondary responsibility that rolled up under another executive. That is no longer optimal and specialized roles should be dedicated to these live-or-die outcomes.
- Chief Data Officer (CDO) / VP of AI & Data Science – If leveraging AI, predictive modeling, or clinical decision support, this leader ensures the company’s data strategy aligns with privacy regulations and clinical effectiveness.
- Chief Engineering Officer (if applicable) – Oversees hardware, biotech platform engineering, or device manufacturing as the company prepares for scaling production.
- Chief People Officer (CPO) / VP of Talent – Essential in scaling teams, attracting talent in a highly competitive biotech and medtech hiring market.
Additional Specialized Roles
- Chief Manufacturing Officer (for Biotech, Med Device, or Pharma Startups) – Ensures scalability of production, meeting GMP and supply chain regulations.
- VP of Market Access & Reimbursement – If insurance, CMS, or private payer reimbursement is critical, this leader ensures early engagement with payers.
- VP of Strategic Partnerships & Licensing – Secures co-development agreements with pharma, hospitals, or insurers.
- Head of Quality Assurance – Ensures that a quality management system is in place to support both regulatory submissions, audits, and eventual approvals.
This stage of your company is all about hitting the ground running and avoiding any missteps that would cause investors to lose trust in the management team. Increasingly, investors will want to see concrete progress and an efficient use of their capital. Experienced and capable personnel are expensive but necessary investments. During fundraising, professional and dedicated attention to detail is the best form of investor relations.
Stage Three: Go-To-Market Stage
The clinical and engineering technical issues are finalized now is the time for selling the product, expanded regulatory approvals, market penetration, and operational scaling. In short, it is time to really start focusing on business people.
- Chief Marketing Officer (CMO) – Leads branding, B2B or B2C healthcare marketing, and demand generation, ensuring physician or patient adoption.
- Chief Sales Officer (CSO) / VP of Commercial Strategy – Drives B2B sales in healthcare networks, hospitals, payers, and provider groups.
- Chief Growth Officer (CGO) – Manages scaling sales, partnerships, and customer acquisition, particularly in direct-to-patient or direct-to-physician models.
- Chief Customer Experience Officer (CXO) – In health tech or SaaS-driven healthcare, this role ensures seamless provider and patient interactions.
- Chief Revenue Officer (CRO) – For companies with payer-based, subscription, or licensing revenue models, ensures optimized pricing, payer engagement, and financial scalability.
- Chief Medical Informatics Officer (CMIO) – Bridges the gap between IT, AI, and clinical workflows, ensuring integration into hospital or healthcare systems.
Additional Specialized Roles
- VP of Government Affairs & Policy – In highly regulated sectors, this role focuses on policy influence, legislative strategy, and compliance with evolving healthcare laws.
- VP of Patient Advocacy & Engagement – If targeting rare diseases, chronic conditions, or underserved populations, this leader manages patient partnerships and outreach.
Hiring the right team matters, but the structure of your management team and when you bring them together depends heavily on your company’s individual needs. In our next article, “Teams 3: Building a Flexible and Scalable Management Team,” we discuss some options on filling interim management roles while meeting a budget.
Michael Schmanske is a 24-year Wall Street veteran with experience on trading desks and asset managers. He is the co-founder of Prognosis:Innovation as well as founder of MD.Capital.
Michael Hufford, PhD, is the Co-Founder and CEO of LyGenesis—a clinical-stage biotechnology company developing allogeneic cell therapies to enable organ regeneration. He has more than 20 years of experience obtaining FDA approvals and leading translational research, regulatory strategy and clinical development across biotech and pharma. Dr. Hufford’s philanthropic work includes co-founding Harm Reduction Therapeutics, a 501(c)(3) nonprofit pharmaceutical company that developed and commercialized RiVive®, a low-cost over-the-counter naloxone nasal spray to help prevent opioid overdose deaths.
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