What Do CEOs Really Want from Their CFOs?

CFOs should be able to show strategic agility, sector fluency and heart, according to these top healthcare executives.

CFOs are no longer just stewards of the bottom line. They’re also strategic leaders shaping the future of care delivery.

The demands on financial executives are as urgent as they are complex, especially for rural hospitals. And according to Martha Henley, CEO of Unity Medical Center, and COO of Java Medical Group, the ideal CFO must blend technical excellence with a deep, mission-driven understanding of the healthcare environment.

“We need someone who can balance strong fiscal stewardship with a deep understanding of our mission to protect healthcare for rural America,” Henley says.

That mission-centric mindset, she says, is essential for aligning financial strategy with core goals like patient access, care quality, and long-term sustainability at any health system.

From Controller to Strategic Partner

At Unity Medical Center, the CFO plays a central role in evaluating digital tools, innovative partnerships, and population health initiatives.

“I rely on my CFO to help us move from reactive budgeting to proactive positioning,” Henley says.

That means identifying opportunities for grant funding, evaluating risk-sharing arrangements, and helping lead the transition to value-based care.

At Winona Health, CEO Rachelle Schultz believes CFOs must bring more than technical financial skills—they also need strategic insight, courage, and relationship-building capabilities to drive meaningful change. The traditional models of healthcare delivery are no longer effective, and CFOs must help lead the transformation.

“We’ve got to reinvent healthcare,” Schultz says. “I think there’s a courage factor in all of that—a willingness to push the boundaries and change the conversations.”

Is Sector Fluency Negotiable?

While broad financial acumen is valuable, healthcare-specific expertise is a must, according to Henley. This is true especially in rural hospitals, where resources are thin and financial complexity and regulatory nuance can make or break the balance sheet.

“There’s no room for guesswork when it comes to things like Medicare cost-based reimbursement, swing bed billing, DSH payments, or the 340B program,” Henley explains.

These mechanisms are often financial lifelines for rural providers.

Yet technical skill alone isn’t enough. The ideal candidate, Henley says, brings “operational grit” and a willingness to dig into how the numbers translate into real-world impact. A spreadsheet doesn’t mean much if it can’t account for staffing shortages, limited access to capital, or the long distances patients must travel for care.

While Schultz acknowledges healthcare-specific financial expertise is valuable, she places greater emphasis on critical thinking, curiosity, and fresh perspective when selecting a CFO. In her experience, hiring leaders from outside the healthcare finance world has brought new ways of thinking and valuable insight, even if it comes with a steep learning curve.

“The fresh thinking that comes in the way of reframing some things or questioning, I think, is really valuable,” Schultz says.

Rather than relying solely on a CFO’s technical knowledge, Schultz ensures that a strong internal finance team supports complex tasks like audits and cost reports. This allows the CFO to focus on oversight, strategy, and broader organizational alignment.

Ultimately, Schultz says she sees the best fit as someone with a solid financial foundation, strong leadership skills, and the ability to challenge assumptions, even if they aren’t a traditional healthcare finance expert.

Leadership That Shows Up

In a rural setting like Unity Medical Health, presence matters. The CFO needs to be a visible, trusted leader, not someone tucked away in an office.

“We’re a small, tight-knit team,” says Henley. “The right CFO should guide critical conversations, foster trust with the board, and model accountability throughout the organization.”

Interpersonal skills—especially emotional intelligence—are just as important as financial credentials. Great CFOs communicate difficult truths with clarity and empathy. They listen well, build cross-functional relationships, and earn the confidence of both clinical and operational staff.

Kurt Barwis, CEO of Bristol Hospital, agrees that interpersonal skills are a vital element to what makes a CFO a strong, strategic partner of the organization.

"The CFOs of the future really do have to have that strategic knowledge," says Barwis. "They may be smart, but you can't put them at the top of your organization if they have no people skills, no interpersonal skills, and, most importantly, no self-awareness skills."

Schultz highlights the value of curiosity and empathy in financial leadership, as well as  approaching challenges with a mindset of inquiry rather than blame. Essentially, great CFOs must be financially grounded but strategically bold, capable of seeing the full playing field and connecting the dots to build a more sustainable healthcare system.

Influencing Innovation

Schultz sees the modern CFO as going far beyond traditional financial oversight, emphasizing the need for deep engagement in innovation, value-based care, and population health. Winona Health’s current CFO, Jessica Remington, exemplifies this expanded role through active involvement in business development, partnerships with payers, and initiatives addressing social determinants of health.

Schultz says the CFO has also been instrumental in leveraging technology to improve care delivery, working on everything from EMR infrastructure to enhancing the patient and provider experience. This broad engagement allows alignment of financial strategy with operational and clinical priorities.

“It’s that overall system insight to understand what’s the flow of information, what is the flow of the data, what is the flow of the clinical process, what is the flow of the financial process or the quality process,” Schultz explains.

Ultimately, the CEO values a CFO who brings cross-functional expertise and stays actively involved in shaping the broader system, ensuring that innovation, finance, and care delivery are tightly integrated.

The Bottom Line: It’s About Mission, Not Just Margin

Schultz says what distinguishes a great CFO in healthcare is their ability to lead through people, foster collaboration, and build inclusive, resilient teams.

“It’s more about where are all of the great ideas and how are we pulling them all together—and then how do we make these things happen?” Schultz says.

In rural care settings, where today’s uncertain reimbursement models hit the organizations particularly hard, CEOs want CFOs who can lead with heart as well as mind. They must see every line item as more than dollars, and realize it’s about lives, community trust, and the sustainability of care where it's needed most.

“A great CFO understands the weight of their decisions and the lives those decisions impact,” Henley says. “That perspective—and that heart—is what separates good from great.”