Your Fractional Development + Design Partner
For a flat monthly retainer, I become a trusted member of your team, delivering code, design, and strategic output every single week. No hourly billing, no scope theatrics, and no surprises.
I partner mainly with healthcare and insurance teams that need a senior engineer who also "gets" UX and reliability. Instead of juggling multiple freelancers or waiting on quotes, you get a single point of contact who understands regulated environments and builds reliable systems for health & insurance—while staying easy to work with.
Most long-term retainers start around $7,500/month, with more complex, multi-system work typically in the $10,000+/month range.
What You Get
- Solve complex front-end, back-end, and UX challenges
- Implement HIPAA-aware, secure web applications & infrastructures
- Get strategic insights from a senior engineer who cares about your bottom line
- Enjoy steady momentum: no re-onboarding or negotiating scopes
- A fully insured contractor with good security best practices for your General Counsel's peace of mind
How I Work
Most freelance developers will bid on a project, deliver the scope, and move on. That leaves you with the burden of ramping up a new dev the next time something changes, or worse, a half-finished product if the scope wasn't perfectly defined up front.
I work differently. Through a flat monthly retainer, I become your fractional engineer/designer and product partner. I stay close to your roadmap, I understand your constraints, and I keep your systems moving forward without you having to constantly reset context.
Instead of selling hours, I optimize for reliability and continuity:
- I work in deep, focused blocks rather than scattered time
- I keep you in the loop with light, predictable communication
- I only take on two to three ongoing retainer clients at once, so your work doesn't compete with a dozen other projects
Need to pivot or add new features? We adapt on the fly. My priority is to keep your product moving forward and your systems stable.
Who This Is For
- Early-stage Healthcare Startups
Need a fractional lead engineer to shape your tech vision and actually build it out? I can do both, so you can focus on customers, fundraising, and growth. - Small-To-Mid-Size Healthcare & Insurance Companies
If you have a product team but need an experienced engineer/designer who can ship features quickly and handle tricky technical decisions, let's talk. - Established Healthcare Businesses & Innovation Teams
Want to prototype a new product or internal tool without pulling your core dev team off the main roadmap? I'll plug in as a long-term partner and move fast while maintaining best practices.
Guiding Principles
- Partners, Not Clients.
Your success is my success, so I care about your product's performance as if it were my own startup. My goal is to align my work with your business impact, not just project deliverables. - Focus On The Next Most Useful Thing.
Momentum is gold. I'm always thinking about how to remove blockers and push your product forward—whether that's implementing a new feature, refining your UI, or improving internal tools. - Forward-Thinking & Grounded.
My approach is positive yet realistic—finding solutions that move us forward while staying mindful of technical constraints. - Strategy & Hands-On Work.
I like being involved in both "big picture" architecture and day-to-day implementation. Strategy without execution is theory; execution without strategy wastes resources. - Numbers & Empathy.
Data can guide us, but in healthcare you also need to understand people. I care about both: measurable impact and the experience of the people using your tools.
Capabilities
- Front-End: React, Next.js, Tailwind, design systems, polished UI/UX
- Back-End: Node.js, Express, Laravel, Django, serverless, GraphQL/REST APIs, secure DB integration, HIPAA-aware design
- Design & Prototyping: Figma, interaction design, iterative UX validation
- Product Strategy: MVP planning, feedback loops, roadmap design for health & insurance products
How We'll Work Together
This is a long-term, calm, and predictable way of working. We keep communication light but reliable, and we prioritize your systems' health over meeting volume.
Kickoff & Alignment
We'll discuss your goals, existing process, and top priorities. I'll happily sign a BAA before starting work. From there, I map out the systems, constraints, and quick wins—and then I jump in.
Weekly 15-Minute Alignment Call
Once a week, we have a short, focused call to confirm priorities, surface risks, and make any decisions that are easier synchronously. This is not a status meeting—status comes async. It's a quick touchpoint to keep us tightly aligned without filling your calendar.
Weekly Written Reports
Every week, you get a concise written report covering what shipped, what's in progress, upcoming work, and any risks or recommendations. This becomes a single source of truth for you and your stakeholders.
Centralized Task Planning That Plays Nice With Your Tools
If one team uses ClickUp and another uses Asana, you don't have to change anything. I maintain a small "consulting command board" (e.g., in Notion or Linear) where I track my commitments and priorities, and I mirror relevant tasks into your existing tools. Your team sees everything where they already live; I keep the overall picture coherent.
Embedded in Your Team (Without Taking Over Your Calendar)
We'll use Slack or your preferred channels for day-to-day communication. You can assign me work via your project management tool, and I'll keep it flowing. I don't depend on daily standups to move forward—but if you have a ritual that's truly high-leverage, we can work it in as long as it's async.
Continuous Delivery
I don't waste time writing quotes for every feature. I ship production-ready code/design on a steady rhythm, with demos or Loom walkthroughs whenever something noteworthy is ready to review.
Adapt & Scale
Whether your product needs a quick pivot, a new integration, or refactoring to handle more load, I'm flexible. You have a fractional engineer & designer who can grow the system with you—without the stress of constant renegotiation.
Who I Work With
Since 2012, I've collaborated with a wide range of clients worldwide—from small design agencies to multi-million-dollar companies such as LinkedIn and KonMari Media. My projects have been featured in TechCrunch, NBC News, The Wall Street Journal, NPR, and Time Inc., among others.
Monarch
I built and launched a medical membership platform that generated hundreds of thousands of dollars within its first weeks. I delivered the MVP in seven days and later helped lead a rebrand and a back-end migration to a more robust system. This is an ongoing project I'm proud of and excited to keep evolving.
Leap Health
Leap is the only US nationwide infusion provider specifically designed for employers, helping them receive transparent pricing on specialty drugs. I've led multiple engineering efforts for Leap's complex healthcare data requirements:
- Architected and built a desktop claims analysis platform that ingests millions of healthcare records and replicates expert analyst judgment—achieving ~99% parity with manual reviews and compressing hours of work into minutes.
- Built a web-based scalable drug pricing intelligence system that harmonizes multiple datasets and applies analyst-grade logic to compute optimal treatment costs at scale.
- Drove infrastructure decisions for healthcare data processing workloads and implemented cross-platform deployment and CI/CD pipelines for smooth delivery.
Graphite Health
Led the front-end development for Graphite's website redesign, creating a high-performance and visually compelling platform serving both investors/collaborators and top talent. Implemented Sanity as the CMS and integrated various third-party tools with custom-built solutions.
Looking Glass Factory
For over six years I helped Looking Glass Factory move from a legacy WordPress site to a modern, conversion-focused e-commerce platform powered by Shopify and a Headless CMS. We also shipped other customer-facing products, like an app for turning 2D photos into 3D/holographic portraits.
"I've worked with Mariano for 6 years and he has always come through with incredible skill for us with our most challenging projects. He was instrumental in several major updates to our website. If you get a chance to work with Mariano, take it!"
Feels Like Studio
I collaborated with Feels Like Studio on multiple high-profile projects under NDA, including work for a major American entertainment company. My contributions spanned the full stack, from design improvements and front-end implementation to backend security hardening.
"He is organized, responsible, self-directed, reliable, and extremely competent. He regularly showed initiative above and beyond the original request."
FAQ
Let's Work Together
I work on a flat-rate monthly retainer. Most long-term retainers start around $7,500/month, and more complex, multi-system work typically ranges from $10,000+/month. I ask for 50% of the first month's retainer upfront before we start.
I intentionally limit myself to just two or three ongoing retainer clients because great work requires focus. I may not always have a spot open, but I'm always open to good conversations.
Drop me a line at office@marianomiguel.com to book a call.