Chief Operating Officer (COO) – Skilled Nursing Operations

Legacy Healthcare; Oklahoma City (OK); On-site; USD 150,000 - 230,000; Full time

Job summary

Legacy Healthcare seeks a hands-on Chief Operating Officer (COO) to lead seven skilled nursing facilities. The role combines operations, clinical performance, and financial stewardship to drive census growth, quality, and profitability.

The COO will partner with Administrators, DONs, and leadership teams, setting clear standards, monitoring performance, and implementing turnaround plans where needed. A strong healthcare operations background and willingness to spend time on-site are essential.

Qualifications

• Significant experience in skilled nursing, post-acute care, long-term care, or a closely related healthcare environment.
• Demonstrated experience managing multiple facilities, departments, or complex healthcare operations.
• Strong understanding of SNF operations, staffing, census, reimbursement, quality, and regulatory requirements.
• Strong financial and analytical skills with the ability to understand and manage facility-level P&Ls.
• Proven ability to improve operational and financial performance.
• Strong leadership and communication skills.
• Ability to hold senior leaders accountable while developing and supporting them.
• Willingness to spend meaningful time in the facilities rather than managing exclusively from a corporate office.

Responsibilities

• Provide leadership and accountability for all seven facilities.
• Partner with and hold Administrators, DONs, and facility leadership teams accountable for results.
• Establish clear operating standards and consistent expectations across the portfolio.
• Monitor facility performance through regular operational and financial reviews.
• Drive census growth, occupancy, admissions, and referral development.
• Manage labor costs, staffing levels, overtime, agency utilization, and productivity.
• Review facility P&Ls and identify opportunities to improve revenue, margins, and operating performance.
• Monitor key financial and operational metrics and translate data into action.
• Identify underperforming facilities and develop specific turnaround plans.
• Ensure facilities maintain strong clinical, quality, and regulatory performance.
• Maintain survey readiness and ensure deficiencies are addressed quickly and effectively.
• Monitor rehospitalizations, quality measures, Five-Star performance, and other key clinical indicators.
• Support recruitment and retention of strong Administrators, DONs, nursing leaders, and other key personnel.
• Develop facility leaders and build a strong management pipeline.
• Work closely with ownership on budgets, forecasts, capital needs, strategic initiatives, and growth opportunities.
• Identify opportunities to improve systems, processes, purchasing, vendor relationships, and overall efficiency.
• Ensure accountability through regular facility visits, meetings, dashboards, and performance reviews.
• Create a culture of ownership, accountability, urgency, and continuous improvement.

Skills

Hands-on

Analytical

Accountable

Commercially minded

Operationally strong

Education

Bachelor's degree preferred

Advanced degree in healthcare administration/finance

LNHA license preferred

Job description

Chief Operating Officer (COO) – Skilled Nursing Operations

Location: [OKC, OK]
Employment Type: Full-Time
Reports To: Ownership / CEO

About the Opportunity

We are seeking an experienced, hands-on Chief Operating Officer (COO) to lead the operations of a growing portfolio of skilled nursing facilities (SNFs).

This is a high-impact leadership position for an experienced skilled nursing operator who understands what it takes to run high-quality, financially healthy, well-managed nursing facilities.

The ideal candidate may come from a Licensed Nursing Home Administrator (LNHA), Regional Vice President of Operations, Regional Director of Operations, Executive Director, or similar skilled nursing leadership background.

We are also open to candidates with a CFO, finance, or healthcare finance background who have substantial experience with skilled nursing operations and understand how staffing, census, reimbursement, quality, and operational decisions drive facility financial performance.

This is not a purely corporate or administrative role. The COO will be expected to know what is happening inside each building, understand the numbers, hold leadership accountable, identify problems quickly, and drive measurable improvement.

What You'll Own

The COO will have overall responsibility for the operational and financial performance of seven skilled nursing facilities.

Key areas of responsibility include:

• Provide leadership and accountability for all seven facilities.
• Partner with and hold Administrators, DONs, and facility leadership teams accountable for results.
• Establish clear operating standards and consistent expectations across the portfolio.
• Monitor facility performance through regular operational and financial reviews.
• Drive census growth, occupancy, admissions, and referral development.
• Manage labor costs, staffing levels, overtime, agency utilization, and productivity.
• Review facility P&Ls and identify opportunities to improve revenue, margins, and operating performance.
• Monitor key financial and operational metrics and translate data into action.
• Identify underperforming facilities and develop specific turnaround plans.
• Ensure facilities maintain strong clinical, quality, and regulatory performance.
• Maintain survey readiness and ensure deficiencies are addressed quickly and effectively.
• Monitor rehospitalizations, quality measures, Five-Star performance, and other key clinical indicators.
• Support recruitment and retention of strong Administrators, DONs, nursing leaders, and other key personnel.
• Develop facility leaders and build a strong management pipeline.
• Work closely with ownership on budgets, forecasts, capital needs, strategic initiatives, and growth opportunities.
• Identify opportunities to improve systems, processes, purchasing, vendor relationships, and overall efficiency.
• Ensure accountability through regular facility visits, meetings, dashboards, and performance reviews.
• Create a culture of ownership, accountability, urgency, and continuous improvement.

What We're Looking For

We are looking for a builder and operator, not simply someone who produces reports.

The successful candidate will have a strong understanding of the realities of operating skilled nursing facilities and will be comfortable moving between operations, people, clinical performance, and financial results.

Preferred Background

Candidates may come from a variety of backgrounds, including:

• LNHA / Nursing Home Administrator
• Regional Director of Operations
• Regional VP of Operations
• Multi-Facility SNF Executive
• SNF Executive Director / Administrator
• Healthcare COO
• SNF CFO or healthcare finance executive with significant operational experience
• Senior healthcare operations leader

Qualifications

• Significant experience in skilled nursing, post-acute care, long-term care, or a closely related healthcare environment.
• Demonstrated experience managing multiple facilities, departments, or complex healthcare operations.
• Strong understanding of SNF operations, staffing, census, reimbursement, quality, and regulatory requirements.
• Strong financial and analytical skills with the ability to understand and manage facility-level P&Ls.
• Proven ability to improve operational and financial performance.
• Strong leadership and communication skills.
• Ability to hold senior leaders accountable while developing and supporting them.
• Comfortable using data and KPIs to identify problems and drive decisions.
• Strong problem-solving and decision-making skills.
• Willingness to spend meaningful time in the facilities rather than managing exclusively from a corporate office.
• Bachelor's degree preferred; advanced degree or healthcare administration/finance background is a plus.
• LNHA license preferred but not required for the right candidate.

The Person We're Looking For

The right person is:

Hands-on. Analytical. Accountable. Commercially minded. Operationally strong.

You should be someone who can walk into a facility, talk with the Administrator and DON, review staffing and census, look at the P&Ls, identify the biggest problems, and develop a practical plan to fix them.

You don't have to be the smartest person in every room. You do need to know how to build strong teams, ask the right questions, recognize problems, and make sure things get done.

We're particularly interested in leaders who have successfully improved the performance of struggling facilities and can demonstrate measurable results.

How Success Will Be Measured

Success in this role will be measured by improvements in:

• Occupancy and census
• Revenue and reimbursement
• Operating margin / EBITDA
• Labor and agency costs
• Staffing stability
• Quality outcomes
• Survey performance
• Five-Star ratings
• Hospital readmissions
• Employee retention
• Administrator and leadership performance
• Overall consistency and performance across the seven-facility portfolio

Why Join Us?

This is an opportunity to have a direct impact on a multi site-facility skilled nursing portfolio and work closely with ownership.

You will have meaningful authority and accountability, with the opportunity to improve the way the organization operates, develop strong facility leaders, improve financial performance, and ultimately create better outcomes for residents and employees.

If you are an experienced skilled nursing operator who enjoys solving problems, improving buildings, developing people, and driving results, we would like to hear from you.

Compensation will be competitive and commensurate with experience, with potential for performance-based incentives.