Make better 

decisions, faster

Fractional COO, project-based consulting, and strategic support for early-stage health tech, AI, and mission-driven startups.

Josh Green, Fractional COO and Strategic Advisor at RightStart

Meet Josh

At the heart of what I do is a deep belief in supporting people, especially the ones brave enough to build.

I’ve been at that early stage. It’s intense, high-stakes, and messy. The decisions are complex, the systems don’t always make sense, and it’s easy to feel overwhelmed. That’s why I’m drawn to working with early-stage teams doing a lot with limited resources, helping them move through uncertainty and gain real traction without burning out.

I’ve been the first ops hire at multiple startups that went on to be acquired. These days, I work with founders as a fractional COO, advisor, or project lead, bringing calm structure, creative problem-solving, and steady momentum to whatever comes next.

I focus on smart systems and sticky challenges like:

  • Launching OKRs and MVP pilots that actually get used

  • Building hiring pipelines that grow with the company

  • Navigating compliance (like HIPAA) without losing speed

  • Bridging communication between founders, funders, and teams

I’m especially drawn to health tech and mission-driven startups working to improve systems that impact people when it matters most.

Twice a week, I host open office hours. No pitch. Just space to jam, troubleshoot, or think out loud. Sometimes we unblock something. Sometimes we build a roadmap. Sometimes you send that email you’ve been avoiding, right on the call. It’s all about clarity and momentum.

And if it helps to know who you’re talking to: I’m based in San Francisco, I sing (badly and joyfully) in the gay men’s chorus, and I believe the best work starts with honesty, warmth, and a genuine desire to help others succeed.

How I Can Help

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Fractional COO

Bringing calm clarity and operational structure to fast-moving startups.

  • Helped define strategic goals and hire executive leaders at an AI education nonprofit

  • Scaled a telehealth company to 50 states and quadrupled patient volume in 3 months

  • Developed internal systems that supported growth, retention, and team culture at a national nonprofit

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Project Consulting

Short-term support for complex, high-stakes initiatives.

  • Led HIPAA compliance and launch readiness for a virtual care startup

  • Built a provider hiring pipeline for nutrition therapy platform

  • Designed and implemented automations for an orthodontic healthtech MVP

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Advising

Ongoing support, honest feedback, and traction-focused guidance.

  • A space to think clearly, ask the hard questions, and move things forward

  • Weekly calls or check-ins to stay grounded, focused, and accountable

  • Real-time support and in-the-moment solutions tailored to what’s actually happening

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Open Office Hours

Free, no-pitch calls to jam, troubleshoot, or think out loud.

  • A low-stakes way to talk through what’s working (or not)

  • Space to clear a block, gut-check an idea, or sketch next steps

  • Open to founders, operators, and curious collaborators

Let’s Build What Works

If you’re building something ambitious and need clarity, structure, or a trusted partner to figure it out together, I’d love to talk. I’m based in San Francisco and work with founders across the country.

If you’re like to brainstorm, troubleshoot, break something down or find out what it would look like to work together, book time during my office hours and we’ll dive in.