Chief Executive Officer - Pediatric Medical Day Care Platform

Chief Executive Officer

Location: San Antonio, TX (relocation supported) · National travel Reports to: Board of Directors Type: Full-time, executive Compensation: Up to $2,000,000+ base, plus significant equity

The vision

We are building the first national brand in pediatric medical day care — a platform of hundreds of Prescribed Pediatric Extended Care Centers across the United States.

Today there are roughly 180 licensed centers in the entire country, operating in 15 states. Texas alone has the demand to support more than 40. Extrapolated across the states that already have a benefit, the category should be a thousand centers or more. It has stayed small because reimbursement policy suppressed it, not because families didn't need it — and that constraint is now being removed state by state.

Nobody has built the national brand. The category is still single sites and small regional operators — no consistent standard of care, no recognized name, no platform at scale.

That is what we intend to be. Hundreds of centers, one brand, one clinical standard, one operating model — and the real estate underneath all of it.

About the opportunity

A Prescribed Pediatric Extended Care Center (PPECC) is a licensed medical day center for children with complex medical needs — ventilator dependence, tracheostomies, feeding tubes, seizure protocols. Skilled pediatric nursing, on-site therapy, developmental programming and supervised transport, reimbursed by Medicaid. It costs the state less than extended hospitalization and less than round-the-clock home nursing, and it allows a parent who left the workforce to return to it.

Our capital structure, real estate strategy and site pipeline are in place. Our first center is in development in a fully built out building in San Antonio with the potential to build additional centers on the same land. We are hiring the CEO who will open it, prove the model, and scale it nationally.

This is a pre-launch role. No centers are currently operating. The person who takes this seat builds the platform from the first location.

How this is structured — and what we already have

Our board is led by a former Assistant Secretary of the U.S. Department of Health and Human Services — direct experience with how federal coverage policy is made, in a category defined by it.

The platform operates as two companies. A property company owns the real estate under every center. An operating company runs the clinical business and leases from it. Both accrue to the same ownership group.

The real estate side is solved. Our partner on the property company manages approximately $500 million in assets under management, with deep development and property management experience directly relevant to this asset class. They handle site acquisition, entitlement, ground-up development, construction management, financing and property management across the portfolio. Not a gap we are hiring against — though if you have this expertise, it's a plus.

The operating side is what we are hiring for. Licensure, clinical leadership, staffing, referral development, revenue cycle, census, quality, and the multi-site playbook that turns one center into hundreds. This role owns it.

A CEO who can operate across both is ideal — someone who understands how site selection drives census, how the lease supports the capital stack, and how the real estate compounds alongside the operating business. But we are hiring for operating depth first. We will not trade clinical and multi-site operating excellence for real estate fluency, because we already have the second.

Must-have skills

Non-negotiable. A candidate strong across these is one we want to speak with, whatever their title.

1. De novo site opening in a licensed healthcare setting. You have personally taken facilities from licensure application through architectural plan review, life safety inspection and state survey to first patient day. Not overseen a footprint someone else built — opened them. You know where the schedule slips and what it costs.
2. Clinical workforce building in a shortage market. Pediatric nursing supply is the binding constraint — not capital, not real estate, not demand. You have built a nursing pipeline, hired and retained qualified clinical directors, managed turnover in a competitive labor market, and know your own retention numbers without having to look them up.
3. Regulatory, licensure and survey command. You have owned the relationship with a state licensing authority. You have been through inspections, received deficiencies, written and executed plans of correction, and built compliance infrastructure that holds up across multiple sites and eventually multiple states.
4. Government-payer revenue cycle. You have carried a P&L that was predominantly Medicaid or Medicare. You understand managed care contracting, prior authorization, medical necessity documentation, denial management and appeals — and you understand that in this category the denial rate is a leadership metric, not a billing metric.
5. Census and referral development. You have built demand from zero. You know how to earn the confidence of hospital discharge planners, complex-care physicians and specialty clinics, and you know these relationships are personal, slow to build, and the largest determinant of whether a center reaches breakeven on schedule.
6. Multi-site scaling — not multi-site management. You have taken an operating model from one location to many and know precisely what breaks between site three and site ten. You have built the centralized layer — billing, EMR, HR, compliance, quality — that makes unit economics improve with scale rather than degrade.
7. Full P&L ownership and unit economics fluency. You can speak to census ramp curves, contribution margin per patient, breakeven census and the working capital a ramp consumes. You have made the call on when a location is underperforming and what to do about it.
8. Executive team building. You have hired the people who ran your sites and your functions, and you can name both the hires that worked and the ones that didn't.
9. Clinical quality and risk in a medically fragile population. These are children on ventilators and feeding tubes. You bring genuine seriousness about clinical governance, incident management and family trust, and you understand that a single serious event can end a brand.

Ideal additions

Not required — what makes a candidate exceptional rather than merely qualified.

Real estate literacy. Site selection against demand and drive-time catchment, lease structuring, an understanding of how an operating tenant's credit supports property financing, and the ability to work as a peer with the property company rather than a tenant of it.

Prior CEO, board or chairman experience — or a clear appetite for it.

Multi-state licensure experience, including entering a state with no prior footprint.

M&A and integration. Acquiring regional operators will be part of the national build.

Pediatric or medically complex population experience.

Policy and payer engagement at state level.

Note on title. Prior CEO experience is not required. Some of the strongest platform builders were the second or third in command — the COO who opened the sites, the CFO whose model made scaling survivable, the commercial leader who filled them. If you did the building and someone else held the title, you are exactly who we want to hear from — and if you held the CEO title, that works too.

Compensation and equity

Base salary — up to $2,000,000+, commensurate with experience and track record. We are prepared to pay at the top of the market for the right operator.

Annual performance bonus of 50–100% of base, tied to centers opened, census performance, survey outcomes and clinical quality.

Significant equity — in both companies. The CEO participates in the operating company and the property company.

Operating company equity. A meaningful founder-level ownership position, not a management-pool allocation.

Property company participation. A direct stake in the real estate portfolio. Every center is owned rather than leased, and across hundreds of locations that portfolio becomes an asset base in its own right. Operating executives are rarely offered a position in the real estate they generate the credit for. This one is.

Stock option grants available in addition to direct equity, with strike set at current valuation ahead of the first center opening.

Vesting over four to five years, milestone-weighted to centers opened and stabilized.

Acceleration on change of control.

Benefits. Full medical, dental and vision · relocation assistance · executive severance · change-of-control protections.

We would rather pay in ownership than in salary — and we are prepared to do both.

What you will do

Phase one — prove it

Take the launch center from licensure application through Life Safety Code survey to first patient day

Recruit and lead the clinical leadership team, including the nursing director required for licensure

Build referral relationships with children's hospitals, discharge planning, complex-care pediatrics and home health agencies

Establish billing, prior authorization and denial management operations with Medicaid managed care organizations

Drive census from opening to stabilization

Phase two — make it repeatable

Convert the launch center into a documented, transferable opening playbook

Open and stabilize centers.

Build the centralized services layer so that unit economics improve rather than degrade with scale

Recruit and lead the executive team

Phase three — build the brand

Lead multi-state expansion, including acquisition of regional operators where that is the faster path

Establish the clinical standard and brand identity that defines the category nationally

Own the full P&L and report to the board

We are an equal opportunity employer. All qualified applicants receive consideration without regard to any protected characteristic.