Midstream is an AI-native financial operating system for health systems, founded by experienced entrepreneurs and backed by top-tier investors. We give finance, supply chain, and managed care teams real-time visibility into where margin is at risk, with a precise action plan for capturing it before it's gone.

Purpose-built for healthcare's complexity, Midstream transforms structured, unstructured, and external data into instant, contract-aware insights that drive smarter decisions. Our AI agents unify spend and revenue operations across the full back-office, learning and adapting with every interaction and delivering always-on intelligence that no point solution or one-off engagement can match.

We're compressing months to minutes and turning post-period hindsight into in-the-moment foresight. The tempo of healthcare finance is changing, and Midstream is leading it.

The Opportunity

We are looking for a Strategic Finance and Operations Lead to work directly with our CEO on some of the most consequential decisions we make as a company.

You will help build the financial and strategic infrastructure behind those decisions by developing a forward-looking view of the business, evaluating where we should invest, supporting capital strategy, and clarifying the tradeoffs behind our biggest bets.

You will also play a central role in how we work with our investors and Board, from preparing for Board discussions and investor updates to helping shape the story of where the company is going and what we need to accomplish next.

This is an opportunity for someone who has developed a strong financial and strategic foundation and wants to move closer to the outcome. We are looking for someone who is hungry for ownership, learns exceptionally quickly, and wants to help build the company rather than evaluate it from the outside.

How You Will Make an Impact

Shape company level decisions with the CEO

You will take ownership of the analysis and thinking behind some of Midstream's most consequential decisions. You will turn ambiguous questions into clear choices, develop an independent point of view, and work with the CEO to move from recommendation to decision and outcome.

Own the financial and operating view of the business

You will build and maintain the forward-looking view leadership uses to run the company across growth, revenue, headcount, expenses, burn, runway, and capital needs. You will connect the numbers to what is happening across the business, surface the assumptions and risks that matter, and ensure leadership understands how major decisions change our trajectory.

Build trusted investor and Board relationships

You will own the preparation and increasingly the management of key investor and Board interactions. You will develop clear, credible materials and communications, anticipate the questions sophisticated stakeholders will ask, and ensure our performance, strategy, and long-term opportunity come together in a coherent narrative.

Drive capital strategy and fundraising readiness

You will help determine when and why Midstream should raise additional capital and what we should accomplish with it. You will connect operating choices to runway and future financing needs, shape fundraising strategy and projections, and keep the company prepared well before a financing process begins.

Lead high impact priorities across the company

You will step into consequential problems that do not fit neatly within one function and take responsibility for moving them forward. You will build context quickly, work across Product, Engineering, Commercial, Operations, and other teams, challenge assumptions where needed, and stay with the work through execution and outcome.

Who You Are

You have a strong foundation in finance and understand how businesses and investments are evaluated.

You have likely spent several years in private equity, growth equity, venture capital, investment banking, strategic finance, or another highly analytical environment.

You move comfortably between detailed financial analysis and high-level company strategy.

You are intellectually curious and naturally ask why something works the way it does.

You reason from first principles rather than relying solely on established frameworks.

You are comfortable developing and defending a point of view with incomplete information.

You communicate clearly with senior stakeholders and know how to build trust over time.

You have high standards, low ego, and are comfortable challenging assumptions, including those of senior leaders.

You want significantly more ownership in your next role.

Most importantly, you want to build and own outcomes, not simply analyze or advise from the sidelines.