Real Estate Transaction Lead, West

Neko Health; San Francisco (CA); On-site; USD 140,000 - 210,000; Full time

Job summary

Neko Health is seeking a results-driven Transaction Lead for the West region to own site selection, LOI negotiations, and lease execution across healthcare clinics. You will manage brokers, landlords, and timelines, reporting to the Director of Real Estate, US, in a fast-growing startup environment.

You will lead negotiations end-to-end, build deal memos, and coordinate with Legal, Construction, Design, and Facilities to move signed leases into buildout.

Qualifications

• 3–7 years of real estate transaction experience, ideally in healthcare/retail.
• Led end-to-end deals from site identification to signed lease.
• Comfort with startup pace, pressure, and fast timelines.
• Strong written and oral communication with internal and external stakeholders.
• Ability to read/pressure-test lease terms and economics.

Responsibilities

• Pipeline management across West markets including LA, SF, San Diego, Seattle, Portland, and more.
• Lead deals from market entry through signed lease; coordinate brokers and landlords.
• Draft, negotiate, and revise LOIs; manage end-to-end deal process.
• Prepare LOI and Lease Approval Memos with clear economics and risks.
• Maintain landlord relationships across the West region.
• Coordinate with Legal, Construction, Design, and Facilities to move deals forward.
• Adopt and rollout GIS/site- selection platform and lease system.

Skills

Real estate transactions

In-house healthcare/retail exp

Negotiation

Stakeholder comms

Tools

GIS tools

Lease administration platforms

Job description

Mission

Neko is redefining what prevention means, from treating illness when it arrives, to sustaining health before it's ever at risk. Our mission: make data-driven, preventative care accessible to more people, before symptoms appear.
In a single, non-invasive visit under an hour, proprietary technology and direct clinical care combine to deliver personalised, actionable insights. It's a team that thinks in 10x, not 10%. Every role here plays a part in building a world where prevention is the norm, and where your work genuinely helps people live longer, healthier lives.

Role Purpose

We are looking for a driven, transaction-focused real estate professional to own deal execution across the West region. You will be part of a lean, high-velocity expansion team reporting directly to the Director of Real Estate, US. This is not a support role. You will run site selection, lead LOI negotiations, manage broker relationships, and drive leases to execution across a growing portfolio of healthcare retail clinics in your markets.

This is the first Transaction Lead seat on the US team and the West is the region we are opening first. Transaction Leads for the East and Central United States are planned over the following twelve to eighteen months. Together, this team will build the infrastructure, standards, and portfolio that define Neko’s US physical footprint, and you will set the standard the others work to.

What You'll Deliver in the First 6-12 Months

• Pipeline management: identify, evaluate, and advance sites across West markets including Los Angeles, Orange County, San Francisco, San Diego, Seattle, Portland, Phoenix, Denver, and Las Vegas.

• Transaction execution: lead deals from initial market entry through signed lease, managing brokers, landlords, and timelines, at a pace set by the opening plan for the West region.

• LOI negotiation: draft, negotiate, and revise LOIs; own the deal process end to end from first tour to final execution.

• Deal approval memos: build and present LOI and Lease Approval Memos with clear economics, risks, and a recommendation that stands up to executive scrutiny.

• Landlord relationships: build and maintain relationships with institutional and private landlords across the West region.

• Broker coordination: manage tenant rep broker relationships across multiple markets simultaneously; hold brokers accountable to pipeline and timeline standards.

• Cross-functional coordination: work closely with Legal, Construction, Design, and Facilities to move deals from signed lease into buildout.

• Platform adoption: use Neko’s GIS site selection platform and lease administration system as the system of record and contribute to their rollout as the function scales.

Minimum Qualifications

• 3 to 7 years of real estate transaction experience, with meaningful time spent in-house at a healthcare, wellness, or high-growth retail company.

• You have personally led deals end to end, from site identification through LOI to signed lease, in competitive markets.

• Comfort working in a startup environment with real pressure, fast timelines, and limited infrastructure. You build as you go.

• A self-starter who does not need a fully defined playbook to do great work.

• Strong communication skills. You can represent Neko professionally with institutional landlords while keeping internal stakeholders informed concisely.

• Ability to read and pressure-test lease terms, rent schedules, and deal economics. You do not need to build financial models from scratch, but you need to know when a deal works and when it does not.

• Familiarity with GIS tools and lease administration platforms is a plus; willingness to learn them quickly is a must.

• AI: We use AI tools including Claude in daily work and expect you to use them too.

• Based on the West Coast, Los Angeles or San Francisco preferred but not required. You should be within reasonable travel of the markets you cover.

What makes this role different

Most in-house real estate roles at this scale sit inside large corporate structures where deals move slowly, and decisions require layers of approval. At Neko, you will work on a team where your deals matter immediately; your judgment is trusted, and the decisions you make in year one will shape the portfolio for the next decade.

Neko is opening clinics at pace. The US plan moves from a handful of sites today to a 2028 cohort in the dozens and a portfolio in the hundreds by 2030. The infrastructure you build in year one is the infrastructure the whole portfolio runs on.

About the team

You will report to the Director of Real Estate, US. The team today is small and growing quickly. We are building it around regional Transaction Leads covering the West, East, and Central United States, supported by national specialists: a Market Analyst who owns GIS and site scoring, a Real Estate Associate who runs deal support and pipeline operations, and a Lease Administration Manager who owns the lease platform and portfolio obligations. Most of those seats are being filled over the next twelve months, so you will help set the standard rather than inherit one.

The broader group includes Legal, Construction, Design, Architecture, and Facilities, plus a network of tenant rep brokers across US markets. Our European expansion team operates in parallel, and there will be opportunities to learn from and collaborate with that function as the company scales globally.
Neko Health is an equal opportunity employer. We are committed to building a diverse team and an inclusive environment where everyone can do their best work. We welcome candidates from all backgrounds and encourage you to request reasonable adjustments to support your application.