Home health chief operating officer job description
A home health COO makes sure every scheduled visit has a qualified nurse, therapist, aide or caregiver who shows up. The COO runs staffing, scheduling and EVV across the branches, keeps overtime and mileage in check, and plans new territories with the CEO.
By the HireBus team · Updated · Pay data: BLS, May 2025
Median pay, home health care agencies · BLS, May 2025
We're hiring a COO to run operations across our home health and home care lines. You'll own the staffing, scheduling, and EVV systems every branch runs on, plus labor cost and new territories. The Administrator runs the licensed home health agency day to day and answers to the governing body; you give each branch the people, schedules, and tools to make the visits we've committed to.
2. Essential Duties and Responsibilities
Lead the Administrator and HR Manager, and set the standards every branch runs by.
Set staffing plans by branch so open cases and new admissions have nurses, therapists, aides, and caregivers assigned.
Run the scheduling, EVV, and visit documentation systems, and fix the gaps that cause missed or unpaid visits.
Set hiring targets for aides, caregivers, nurses, and therapists with HR, based on referrals and open hours.
Track labor cost, overtime, and mileage with the CFO, and change schedules and routes to control them.
Plan new territories with the CEO and Administrator, including licensing, staffing, and start-up timelines.
3. Key Tasks / Daily Activities
Review yesterday's missed visits, call-offs, and open shifts by branch.
Compare new admissions with available staff and decide where to recruit or move clinicians.
Meet with the Administrator and Director of Nursing on cases that are hard to staff.
Review EVV exceptions and visits that can't be billed yet.
Work through client and family complaints that reached leadership.
4. Key Performance Indicators (KPIs)
Scheduled visits completed: [your target].
Open hours left unstaffed: [your target].
Early caregiver turnover: [your target].
Overtime hours as a share of total hours: [your target].
Visits ready to bill on time: [your target].
5. Required Qualifications and Skills
Bachelor's degree in business, health care administration, or a related field, or equivalent experience.
[7+] years of operations leadership in home health, home care, hospice, or another multi-site health care business.
Has managed scheduling and staffing for a large hourly workforce that works in the field.
Understands how Medicare home health, Medicaid personal care, and private-pay home care each pay, and what each one requires.
Makes decisions from scheduling, EVV, and payroll data.
6. Preferred Experience
Has opened a new branch or territory.
Has rolled out or switched home care scheduling or EMR software, such as [your systems].
Background in nursing or clinical operations.
Has lowered caregiver turnover through onboarding, scheduling, or pay changes.
7. Physical Requirements
Office work at a computer for long periods, with frequent phone and video meetings.
Driving to branch offices and occasionally to clients' homes.
With or without reasonable accommodation.
8. Work Environment and Schedule
Office-based, with regular travel between branches in [your service area].
Regular hours: [Monday through Friday], with evening and weekend calls when staffing breaks down.
Part of the leadership on-call rotation: [your rotation].
9. Compensation and Benefits
Pay: [range and hourly or salary basis].
Additional pay: [overtime, bonus or incentive terms, or none].
Benefits: [health, dental, vision, retirement, paid time off, and when they start].
10. Company Culture and Overview
[Two or three sentences on what your company does, the area you serve, and the support a new chief operating officer gets in the first 90 days.]
11. How to Apply
[Apply link or email]. Our process: [phone interview, in-person interview, and next steps]. Contact [hiring contact] if you need an accommodation during the application process.
Need help filling this role? HireBus posts the ad, Iris interviews every applicant by phone before you do, and you decide who to hire. Start hiring now
Most COOs can walk the floor and see the work. A home health COO can't. Visits take place in patients' homes across several counties, and federal and state rules decide who may fill each one.
Medicaid visits need an EVV record
Under the 21st Century Cures Act, states must require electronic visit verification for Medicaid personal care and home health visits. The system has to record the type of service, who got it, who gave it, the date, the place, and the start and end times. Each state decides which system or systems agencies use, so an agency working in two states may run two of them. Source: CMS: Frequently asked questions on EVV for personal care and home health care services (PDF).
Not every caregiver can cover every visit
A Medicare home health aide visit needs an aide who meets federal rules. That means passing a training and competency program with at least 75 hours of training, or another route the rule allows, such as a state-approved nurse aide program plus a listing in good standing on the state registry. A personal care caregiver who hasn't done that can't fill the gap. Each aide also needs at least 12 hours of in-service training in every 12-month period. Set up scheduling to block those mismatches. Source: 42 CFR 484.80: Home health aide services (Cornell LII).
Supervisory visits go on the schedule too
When an aide serves a patient who also gets nursing or therapy, an RN or therapist must assess the aide's care at least every 14 days. That check is in person, with a rare video exception. Patients with aide care only need an RN visit every 60 days. Each aide must also be watched giving care on a set schedule. The COO plans nurse time for all of it. Source: 42 CFR 484.80: Home health aide services (Cornell LII).
New territories start with state rules
Some states require a certificate of need before a home health agency can open or grow into a new area. Others don't, and the list changes as states repeal or rewrite their programs. Check your state's rules before you sign a lease or hire a branch manager. Then build the hiring plan, so the first referrals have nurses and aides ready. Source: NCSL: Certificate of need state laws.
Labor cost is set on the road
Caregivers drive from home to home, so routes shape overtime and mileage as much as headcount does. A COO who groups cases by town, keeps the same caregiver with each client and fills short shifts early spends less time refilling them later. Branch leaders need those rules in writing, not in the COO's head.
How much home health chief operating officers make
The closest BLS group for home health chief operating officers is chief executives. Chief executives who work for home health care agencies earned a median of $195,580 a year ($94.03 an hour) in May 2025, according to the Bureau of Labor Statistics. That’s below the $213,990 median for chief executives in all industries. About 810 of the 204,350 chief executives in that survey work for home health care agencies.
A salary with a bonus is typical. Build the bonus on completed visits, early caregiver turnover and billing-ready visits rather than labor savings alone, so running short never looks like a win.
Home health care agencies
$195,580$195,580 median Middle half $114,750–$361,060 10th–90th $91,330–$426,770
All industries
$213,990$213,990 median Middle half $129,540–$356,200 10th–90th $75,700–$507,730
10th–90th percentileMiddle halfMedianAnnual pay, May 2025. Source: BLS Occupational Employment and Wage Statistics.
Annual pay by percentile
Group
10th
25th
Median
75th
90th
Home health care agencies
$91,330
$114,750
$195,580
$361,060
$426,770
All industries
$75,700
$129,540
$213,990
$356,200
$507,730
Skills to hire for, and what you can teach
Hire for these
Has kept visits staffed through a hiring shortage or a sudden jump in referrals
Spots a staffing problem in EVV and payroll data before a family calls to complain
Knows what each payer requires before a visit counts, from Medicare to Medicaid waivers to private-pay families
Stays fair and even-tempered with caregivers who call off and families who are upset
Writes branch standards clear enough that managers don't need to call for every exception
Teach these on the job
Your state's EVV system and its exception codes
Your scheduling software and home health EMR
Your branches' counties, drive times and hard-to-staff zip codes
Your mileage, travel time and shift rules
Your past survey findings and the fixes still in progress
A home health COO lives in the scheduling and EVV system (such as HHAeXchange, Sandata or the state's own system), the home health EMR, and payroll. Find out which of those a candidate has run, and whether they have ever moved an agency from one system to another.
Home health chief operating officer interview questions
They have their own page: 6 questions that test this job, what strong and weak answers sound like, and a work exercise to run with your finalists.
The template doesn't set any target for you. Use your own visit, EVV and payroll history, branch by branch, and reset the numbers when census moves.
Scheduled visits completed
Completed visits divided by visits scheduled, from the scheduling system each week, by discipline and branch. Log the reason for each miss: caregiver call-off, patient refusal, hospital stay or no one assigned.
Open hours left unstaffed
Ordered or authorized hours with no caregiver assigned, counted at week's end by branch and county. Track new admissions still waiting on a first visit as their own number.
Early caregiver turnover
Aides and caregivers who leave within their first ninety days, divided by new hires in that group. Review exit reasons with HR each month, and check first-week schedules and drive times when the number rises.
Overtime hours as a share of total hours
Overtime hours divided by all paid hours, from payroll, by branch and pay period. Split overtime caused by open shifts from overtime caused by long drives, so you fix the right problem.
Visits ready to bill on time
Visits with a clean EVV record, signed notes and the needed orders by your billing cutoff, divided by all visits that period. Go over the oldest exceptions with each branch every week.
Start where visits are lost. Pull yesterday's missed visits and call-offs by branch, the open hours on authorized cases, and the EVV exceptions holding up claims. Those three lists show whether the real problem is hiring, scheduling or paperwork. Fix the biggest one before changing software or the org chart.
How much does a home health chief operating officer make?
Chief executives who work for home health care agencies earned a median of $195,580 a year ($94.03 an hour) in May 2025, according to the Bureau of Labor Statistics. The middle half earned between $114,750 and $361,060 a year. Pay also depends on your local market, experience and bonus terms.
What does it take to open a new home health branch?
Medicare's rules make the parent agency report every branch location to the state survey agency, including when it proposes to add one. The parent also gives each branch direct support and administrative control. Plan staff before the sign goes up: nurses for start-of-care visits, aides, and enough RN time for supervisory visits in the new county.
How can a home health COO lower caregiver turnover?
Start with the first two weeks. Give new caregivers a full schedule, short drives and a steady client, not whatever shift happens to be open. Ask branch managers to call each new hire after the first week. Then look at the cases people leave over, such as long drives or hard clients without enough support, and fix those first.
How is a home health COO different from the administrator?
Medicare requires an administrator, appointed by the governing body and in charge of the certified agency's daily operations. The COO's job isn't in Medicare's rules. In this agency the Administrator also reports to the COO, who also covers personal care and owns the systems and labor budget both service lines run on. The administrator keeps the certified agency compliant, and the COO keeps both lines staffed.
