A critical access hospital CEO runs a small rural hospital for its board, from the ER and the beds to the lab and X-ray. The CEO recruits doctors, gets the hospital ready for state surveys, and decides with the board which services the town can keep.
By the HireBus team · Updated · Pay data: BLS, May 2025
We're hiring a chief executive officer to lead our critical access hospital and keep it open, safe and financially sound. You'll answer to the board, work closely with the medical staff, recruit physicians and nurse practitioners to a rural community, and decide with the board which services local patients can count on, from swing beds to visiting specialists.
2. Essential Duties and Responsibilities
Report to the board each month on finances, quality, safety, staffing and strategy, and carry out board decisions.
Decide service lines with the board and medical staff, such as swing beds, obstetrics, surgery, visiting specialists and rural health clinics.
Recruit and keep physicians and advanced practice providers, using state and federal loan repayment programs where they apply.
Keep the hospital ready for survey under the Medicare Conditions of Participation for critical access hospitals, and own every plan of correction.
Maintain transfer, referral, credentialing and quality agreements with network hospitals and tertiary centers.
Set the capital plan with the CFO, including grants, USDA loans and donor gifts for buildings and equipment.
Represent the hospital with county leaders, the state hospital association, employers, donors and local media.
3. Key Tasks / Daily Activities
Meet with the CFO, CNO and HR director on census, cash, staffing gaps and open positions.
Round on the ED, inpatient unit and support departments, and talk with staff on day and night shifts.
Review overnight transfers, safety events and patient complaints, and assign follow-up.
Call or meet with physicians, provider candidates, referral partners and community leaders.
Prepare board and committee materials, and track open action items to closure.
4. Key Performance Indicators (KPIs)
Operating margin: [your target].
Service area market share: [your target].
Survey deficiencies cited: [your target].
Provider and nurse vacancies: [your target].
Patient experience rating: [your target].
5. Required Qualifications and Skills
Bachelor's degree in healthcare administration, business, nursing or a related field.
[5+] years of senior hospital leadership, including direct work with a governing board.
Working knowledge of critical access hospital rules, cost-based Medicare payment and EMTALA.
Experience recruiting physicians or advanced practice providers.
Clear, plain communication with board members, physicians, staff and the public.
6. Preferred Experience
Master's degree in healthcare administration, business or public health.
Experience leading a critical access or rural hospital.
Fellow of the American College of Healthcare Executives (FACHE).
Experience with rural health grants, USDA facility loans, capital campaigns or a health system affiliation.
7. Physical Requirements
Sit for long meetings and work at a computer for much of the day.
Walk all areas of the hospital on rounds, including the ED, kitchen and mechanical spaces.
Drive to partner hospitals, county meetings and state meetings.
With or without reasonable accommodation.
8. Work Environment and Schedule
Hospital office, with regular rounds on clinical units and support departments.
Evening board and committee meetings: [schedule].
Administrator-on-call rotation for nights and weekends: [rotation].
Travel to network hospitals, state meetings and recruiting events: [frequency].
A public role in a small community, including local events and media questions.
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 executive 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.
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What makes running a critical access hospital different
Every CEO answers for results. Here, federal rules written for small rural hospitals also decide how you get paid, who must be on call and how big you can grow.
The designation has limits you manage
Critical access status means Medicare pays for most care based on what it costs the hospital, not set rates. To keep that status, the hospital has no more than 25 inpatient beds, shared by acute and swing bed patients. Its acute stays also have to average 96 hours or less each year. Check every new service or bed plan against those limits first. Source: CMS: Information for Critical Access Hospitals (MLN006400, December 2025).
The emergency room never closes
The hospital must offer emergency care around the clock. A doctor, nurse practitioner, physician assistant or clinical nurse specialist with emergency training or experience must be on call. That person must be able to reach the hospital within 30 minutes, or 60 in some frontier and remote areas the state approves. The cost is the same on a quiet Tuesday night as on a busy Saturday, and the CEO has to fund it. Source: eCFR: 42 CFR Part 485 Subpart F, conditions of participation for critical access hospitals.
Recruiting doctors has legal limits
Signing bonuses, moving costs and income guarantees for doctors can trigger federal referral laws. The Stark law's recruiting exception covers a doctor who moves to your area. The deal must be written and signed, can't depend on referrals, and can't be priced on how many the doctor sends. The doctor must stay free to work at other hospitals. Run every offer past a healthcare attorney first. Source: eCFR: 42 CFR 411.357, exceptions to the physician self-referral rules.
Service line choices are community choices
Keeping labor and delivery, surgery or swing beds open is a board vote the whole town hears about. If you deliver babies, new CMS rules for that care began January 1, 2026, with training and quality rules on January 1, 2027. Some boards look at becoming a rural emergency hospital instead. That ends acute inpatient care. Source: CMS: Information for Critical Access Hospitals (MLN006400, December 2025).
The board answers for quality, through you
Under federal rules, the governing body is legally responsible for how the hospital runs and for its quality program. It also answers for the patient complaint process, unless it hands that to a committee in writing. The CEO brings the board survey findings, safety events, complaint trends and fixes, in plain words it can act on. Source: eCFR: 42 CFR Part 485 Subpart F, conditions of participation for critical access hospitals.
How much hospital chief executive officers make
The closest BLS group for hospital chief executive officers is chief executives. Chief executives who work for general medical and surgical hospitals earned a median of $421,690 a year ($202.74 an hour) in May 2025, according to the Bureau of Labor Statistics. That’s above the $213,990 median for chief executives in all industries. About 3,070 of the 204,350 chief executives in that survey work for general hospitals.
Salary plus benefits, set by the board or its compensation committee. If the board adds an incentive, give quality scores and provider recruiting as much weight as the margin.
General hospitals
$421,690$421,690 median Middle half $259,990–$535,040 10th–90th $176,440–$713,160
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
General hospitals
$176,440
$259,990
$421,690
$535,040
$713,160
All industries
$75,700
$129,540
$213,990
$356,200
$507,730
These figures cover general medical and surgical hospitals of every size. Rural hospitals often pay less than city hospitals. Post a real range for your market in the ad.
Skills to hire for, and what you can teach
Hire for these
Has reported to a hospital board and turned finance and quality data into decisions volunteers can make
Understands cost-based Medicare payment well enough to question the cost report and the budget
Has recruited physicians or nurse practitioners to a small town and kept them past the first contract
Has led a hospital through a state or accreditation survey and closed out the plan of correction
Earns trust from a small medical staff, including the doctors who cover the emergency department at night
Is at ease as a public figure at the county meeting, the grocery store and in the local paper
Teach these on the job
Your state's rural hospital program, hospital association and network contacts
The history behind your transfer, telemedicine and visiting specialist agreements
Your county or hospital district politics and any local tax support
Your monthly board packet and the reports your EHR can produce
Your foundation, its donors and past capital campaigns
Expect board packets, the monthly statements and cost report summary, survey and safety reports, and regular calls with network hospitals. Tell candidates whether the hospital is independent, county or district owned, or run under a management contract or system affiliation, since that decides who the CEO really answers to.
Start each target from your audited results and your last survey, and judge it over a full year. In a hospital this small, one bad month proves little.
Operating margin
Operating income divided by operating revenue, monthly and year to date. Show grants, donations and any tax support on their own lines so the board sees what patient care earns by itself.
Service area market share
Of the inpatient stays, emergency visits and outpatient tests your service area's residents had, the share done at your hospital. Use state discharge data where it exists, plus your own referral and outmigration reports.
Survey deficiencies cited
Count deficiencies from every state, accreditation and complaint survey by severity, and track how fast each plan of correction is in place and whether the fix holds at the next visit.
Provider and nurse vacancies
Budgeted physician, advanced practice provider and RN positions open at month end, plus the hours filled by locum tenens and travel staff to cover them.
Patient experience rating
Your patient survey's overall rating and would-recommend questions, with the count of returned surveys next to each score. A handful of surveys can swing a small hospital's number, so watch the trend.
Career path
Chief Nursing OfficerNursing executives who add finance and board experience can step up, with the medical staff's trust already earned.
Chief Financial OfficerCost report know-how makes a CFO a strong candidate in a hospital paid on its costs.
Chief Executive OfficerRuns the hospital for the board and the town it serves.
System or regional executiveLeads several rural hospitals for a health system, or takes the top job at a larger hospital.
Check your state. BLS notes that every state licenses nursing home administrators, and some health care management jobs call for an RN license. If your hospital also runs a separately licensed nursing home, your state may want a licensed administrator over it. BLS also says certification isn't required, so treat FACHE as a plus.
How much does a hospital chief executive officer make?
Chief executives who work for general medical and surgical hospitals earned a median of $421,690 a year ($202.74 an hour) in May 2025, according to the Bureau of Labor Statistics. The middle half earned between $259,990 and $535,040 a year. Pay also depends on your local market, experience and bonus terms.
What does FACHE require?
To become a Fellow of the American College of Healthcare Executives, a candidate needs a year of ACHE membership and a master's or other graduate degree. They need a current healthcare management job and five years in the field. They also need 36 education credits from the past three years, four volunteer activities and two references. Then they must pass the Board of Governors exam. The template prefers FACHE but doesn't require it.
Does EMTALA apply to a critical access hospital?
Yes. Anyone who comes to the emergency room asking for care gets a medical screening exam, whether or not they can pay. If the exam finds an emergency, the hospital treats it until the patient is stable or arranges a proper transfer. Staff can't hold up the exam to ask about insurance. The CEO owns the on-call lists, transfer deals and training that keep the hospital in line.
Who directs medical care, the CEO or a doctor?
A doctor. Under Medicare's critical access rules, a physician leads medical care and supervises the clinical staff, and the hospital must disclose who that is. The CEO's job is to give the doctors what they need: coverage, equipment, transfer partners and a real hearing when they raise safety concerns.
What does the administrator on call handle?
The after-hours calls that need a leader: a shift no one can fill, a rush in the emergency room, a patient complaint, a power or water failure, or a reporter's question. In a small hospital the CEO and department heads usually share the rotation. Expect finalists to ask how many weeks a year the phone is theirs.
