10 Must-Have Skills for Rural Healthcare CFOs

What sets healthcare CFOs apart?

There’s been plenty written about what makes a modern CFO. Skills like strategic thinking, risk management, and communication keep showing up again and again in research from finance associations. And while we agree, we also know that rural healthcare CFOs live in a different world. Fewer resources. Broader responsibilities. Higher stakes. 

So we asked: what do these skills really look like in your environment?

We pulled from industry research on what makes a great CFO and paired it with insights from our work with, and insight from, more than 400 rural healthcare finance leaders across North America over the past three decades. Because let’s be honest, anyone who can run a hospital facing some of the challenges you face is already operating at an elite level.

What you’ll read about here is a blend of that research, your realities and ideas on how to hone these 10 must have skills — ideas that are meant to be practical and adaptable, not theoretical.

1. Financial expertise: More than numbers and spreadsheets

Sure, every CFO needs to know their way around a balance sheet. But in rural healthcare, it’s about making magic happen with limited resources. You’re the expert who stretches government, grants, Medicaid and Medicare payments, insurance reimbursements, and community donations to deliver top-tier patient care. You know more than anyone, it’s not just about understanding the numbers; it’s about making them work harder for you.

If you’re looking to strengthen this skill, one of the best things you can do is build time into your routine for strategic review.

• Go beyond just reporting the numbers — ask what they’re telling you.
• You might run scenario plans to test different assumptions.
• Use peer networks to exchange strategies.
• Carve out time to stay current on funding shifts or policy changes that affect reimbursement.

Think of it as sharpening the lens you use to evaluate risk, spot trends, and advise your organization.

2. Strategic planning: Thinking five moves ahead

Growth in a rural hospital isn’t just about expansion; it’s more often about sustainability. You’re constantly thinking five moves ahead: anticipating reimbursement shifts, optimizing service lines, and ensuring the ER doesn’t run out of funds (or staff). Your ability to plan for what’s coming — even when the road ahead is foggy — is what keeps your hospital running.

To strengthen this skill, start by making time for structured forecasting.

• What happens if reimbursement drops? Or if your patient volume shifts? Running those scenarios now can save you from tough surprises later.
• You’ll also want contingency plans for disruptions — things like staffing gaps or supply chain issues. Even a basic playbook can help you respond faster and more confidently.
• And don’t go it alone. Building relationships with healthcare coalitions can help you stay informed on policy changes that could affect your strategy down the line.

This is about keeping your hospital viable, even when the future feels uncertain.

3. Risk management: Because ‘what if’ is your middle name

Cyber threats? Reimbursement delays? A once-in-a-generation pandemic? You’ve already faced them all. Rural healthcare CFOs don’t just mitigate risk; they stare it down and come up with plans A, B, and C before anyone else even realizes there’s a problem. You know that a small misstep could mean the difference between keeping a department open or cutting services.

You can build confidence in this area by regularly reviewing your financial risk assessments.

• Are they up to date? Do they reflect today’s threats, not just yesterday’s?
• On the tech front, partner with IT to make sure cybersecurity protocols are solid and preventive, not just reactive. A ransomware attack or data breach doesn’t just cost money; it stalls operations.
• Look at ways to spread risk. That might mean expanding into outpatient services, exploring specialty partnerships, or piloting value-based care models that bring in more stable revenue.

You can’t eliminate every risk. But you can lead your organization with eyes wide open and a plan in place.

4. Leadership and team management: How to develop and support your people

In smaller finance teams, leadership isn’t about staying in your lane. It’s about lifting everyone around you. You’re leading a team that might be small but mighty - often wearing multiple hats. The billing expert is also the executive administrator, and the finance team might be just you. Leading in this environment means getting buy-in, keeping morale high, and making sure everyone feels the impact of their work, and can be as efficient as possible doing it. It’s not just leadership; it’s leadership on hard mode.

You can build strength in this area by investing in skill development.

• Cross-training is also huge. It helps your department stay flexible when staffing gets tight or unexpected work pops up.
• And don’t underestimate the value of mentorship. Helping your team see a path forward keeps them engaged and builds leadership capacity from within.
• At Multiview, we’ve created a Learning Lab for exactly this reason; to help our clients and their team keep learning, cross-train faster, and get more out of the system they already have.

Ultimately as a great leader, you want to give your team room to grow beyond their current roles.

5. Technological proficiency: Doing more with less

Technology is changing fast, and while rural hospitals may not have the biggest budgets, that doesn’t mean you can’t lead digital transformation. In your case, the challenge isn’t just adopting tech, it’s making it work with often clunky systems, tight budgets, and staff who are already stretched thin. Still, you find ways to innovate, because you know that the right tech can bridge the gap for patients who can’t travel miles for care.

To nurture this skillset, look for low-cost, high-impact technologies that support your hospital’s top priorities.

• Work hand-in-hand with your IT team to make sure new tools are sustainable — not just shiny.
• And don’t forget to explore funding options. Many of our clients have tapped into grant programs to pay for tech investments, including their ERP systems.
• Those dollars are out there — you just need a plan to access them.

You don’t need to be a tech expert. But you do need to understand which tools can help you drive better outcomes, both financially and operationally.

6. Communication skills: Translating CFO-speak into human-speak

In a rural hospital, your job isn’t just about managing the numbers; it’s about making those numbers mean something to everyone else.

You’re often the bridge between finance and operations. Whether you’re presenting to the board, guiding department heads, or advocating for funding, your ability to translate financial data into real-world action is key.

One way to grow in this area is to focus on storytelling.

• Numbers alone don’t move people, but stories do. Help your audience see the “why” behind the figures.
• You might also hold short financial literacy sessions for department leads to boost confidence in interpreting budgets and P&L.
• And don’t underestimate the power of a clean, visual report.

The clearer your takeaways, the easier it is for others to act on them.

7. Adaptability and innovation: The ultimate pivot master

Rural hospitals don’t have the luxury of a ‘wait and see’ approach. The landscape is always shifting -  payer models, patient demographics, new regulations. You have to be quick, creative, and unafraid to try new solutions. 

To get stronger here, stay plugged in.   

• Industry groups and thought leaders can offer fresh ideas, case studies, and practical tips you can bring back to your team.
• You can also build this mindset into your culture. Encourage staff to suggest changes, even small ones. Some of the best operational improvements start at the front lines.
• And when you’re trying something new — whether it’s a service line tweak or a different billing approach — start with a pilot. It gives you space to learn, adjust, and scale with confidence.

 Your ability to adapt - and help others adapt - is what keeps things moving forward.

8. Analytical skills: Sherlock Holmes, but for healthcare finance

Strong analytical skills help you see the full picture, and make decisions with clarity, not just instinct. In rural healthcare, every financial move matters. So the ability to break down cost structures, spot revenue opportunities, and forecast accurately becomes a major advantage.

Some thoughts on sharpening this skill...

• Automate the things that eat up your time, like reconciliations and month-end reports. That frees you up to focus on bigger priorities
• You can also build dashboards that bring financial and clinical data together —because trends don’t happen in silos.
• And if you’re not already benchmarking, it’s worth doing. Comparing your performance with similar rural hospitals helps you spot gaps and set more realistic targets.

Rural healthcare CFOs are part detective, part economist.

9. Ethical standards: Because integrity is non-negotiable

When you’re working in a rural community, trust is everything. Patients and staff alike need to know that financial decisions are made with their best interests at heart. Whether it’s transparent budgeting or making the hard calls about resource allocation, you lead with integrity, because your reputation isn’t just professional, it’s personal.

That’s why maintaining financial integrity isn’t just about compliance, it’s about trust.

• To lead with that trust, start by fostering a culture where ethics are part of everyday decision-making, not just something you think about when there’s a problem.
• Put clear, practical policies in place around transparency and reporting. And don’t just set them; review them regularly.
• Internal audits can be a proactive tool, too. They’re not about pointing fingers; they’re about surfacing risks early so you can address them with confidence.

In your environment, ethics aren’t abstract — they’re visible.

10. Advocacy and influence: CFO by day, influencer by night

CFOs in rural healthcare often need to be their hospital’s strongest advocate.

Need more funding? You’re working with local government, convincing donors, and making your case with insurers. Need buy-in from the board? You’re painting a vision for the hospital’s future that everyone can get behind. Rural healthcare CFOs don’t just manage finances — they sell their vision for financial sustainability every single day.

To build on your advocacy and influence skills:

• Strengthen your relationships with health advocacy groups and local leaders. They can be powerful allies in shaping funding opportunities and policy awareness.
• Consider how you present your hospital’s impact; especially when asking for support.
• Storytelling matters here too, whether you're writing proposals or meeting with board members.

Your voice carries weight. Use it to show how every dollar connects to patient care and community health.

The (real) takeaway? You’re not just a CFO. You’re a lifeline.

Rural healthcare CFOs operate at a level many finance leaders wouldn’t last a week in. You’re balancing impossible budgets, keeping services afloat, and ensuring patients get the care they need. It’s a tough job, but someone’s got to do it. And lucky for your hospital, that someone is you.

So next time you hear about what ‘modern CFOs’ should be doing, remember: you’re already ahead of the game. Keep doing what you do best — because your community is counting on you.

Want to talk more about what’s working (or not) in rural healthcare finance? Let’s connect.