Chief Financial Officer

Fractional CFO / Controller

About Zest Health

Zest Health is redefining chronic dermatology care through a tech-enabled, value-based model focused on psoriasis and eczema. Backed by a $13M seed round and incubated within the Roivant ecosystem, we partner with leading health plans to reduce specialty drug spend while improving patient outcomes. With over 2M lives under contract and rapid growth ahead, we’re building the category leader in value-based dermatology.

The Role

We are seeking an experienced finance partner to serve in a hybrid Fractional CFO / Controller capacity. This role spans both day-to-day accounting operations and strategic financial leadership. The right candidate is either a senior individual with demonstrated range across both functions, or a small firm where controller-level staff handle execution and a CFO-level principal provides strategic partnership.

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Scope of Work

Controller / Operational Accounting

• Full-cycle AP/AR and invoice management
• Payment tracking and vendor reconciliation
• Payroll reconciliation
• Monthly close and financial statement preparation
• Balance sheet and P&L development
• Monthly internal reporting development
• Ramp platform administration: invoices, reimbursements, and expense tracking
• New bank account setup
• Coordination with external tax preparer
• Optional: equity issuance tracking and cap table reporting support

CFO / Strategic Finance

• PC/MSO structure fluency—understanding how revenue flows between MSO and PC entities and accounting for it correctly
• Financial forecasting and cash flow modeling
• Scenario planning and runway analysis
• Investor-ready reporting and board-level financial narrative
• Ongoing reporting to Roivant Sciences per the cadence below

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Roivant Reporting Requirements

A core component of this engagement is timely, accurate reporting to Roivant Sciences. Candidates should review the following requirements carefully before expressing interest.

Monthly — due by business day 5:

• Balance sheet and income statement with flux explanations for line item changes >10%
• Capitalization table
• Cash and balance sheet reconciliations
• Cash runway analysis (forward-looking: timing and amount of next capital need)
• Revenue breakdown by customer, including revenue recognition methodology and any new or modified contracts

Quarterly — due by business day 7:

• Completed Roivant questionnaire addressing: fundraise status, leases, non-routine transactions, new bank accounts, litigation/settlements, 409A updates, unique equity grants, intercompany transactions, and any SOX issues or findings
• Summary of quarterly highlights

Adherence to these deadlines and responsiveness to follow-up questions from Roivant are essential requirements of this role.

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Qualifications

Required:

• Experience supporting companies operating under a PC/MSO structure
• Prior work with venture-backed or early-stage companies, ideally at seed or Series A
• Hands-on controller experience—direct ownership of the monthly close, not oversight only
• Familiarity with investor or parent-company reporting requirements
• Proficiency with Ramp or comparable spend management platforms
• Familiarity with QuickBooks
• Experience with Insperity (PEO) payroll reconciliation, or ability to demonstrate a clear onboarding path

Preferred:

• Background in digital health, healthcare services, or managed care
• Experience supporting 409A processes and cap table management
• Prior experience establishing banking infrastructure across multiple healthcare entities

We welcome inquiries from both individual fractional practitioners and small advisory firms with relevant healthcare finance experience.

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How to Apply

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