This work presents Bio-RV, a compact and resource-efficient RISC-V processor intended for biomedical control applications, such as accelerator-based biomedical SoCs and implantable pacemaker systems. The proposed Bio-RV is a multi-cycle RV32I core that provides explicit execution control and external instruction loading with capabilities that enable controlled firmware deployment, ASIC bring-up, and post-silicon testing. In addition to coordinating accelerator configuration and data transmission in heterogeneous systems, Bio-RV is designed to function as a lightweight host controller, handling interfaces with pacing, sensing, electrogram (EGM), telemetry, and battery management modules. With 708 LUTs and 235 flip-flops on FPGA prototypes, Bio-RV, implemented in a 180 nm CMOS technology, operate at 50 MHz and feature a compact hardware footprint. According to post-layout results, the proposed architectural decisions align with minimal energy use. Ultimately, Bio-RV prioritises deterministic execution, minimal hardware complexity, and integration flexibility over peak computing speed to meet the demands of ultra-low-power, safety-critical biomedical systems.