Hiring a NEMT operations manager: when you need one, what the job covers, and what to pay

What the owner hands over

An operations manager runs the service day to day so the owner can work on contracts, rates, and cash. In a NEMT company the job usually covers five areas:

• Service. The schedule, the dispatch desk, on-time results, will-call returns, and same-day problems. Dispatchers report to the manager.
• Drivers. Shift patterns, call-outs, ride-alongs, coaching, and discipline, plus the training records brokers ask to see.
• Vehicles. Inspections, maintenance intervals, spares, and pulling a van from service when it fails a check.
• Credentials. The driver and vehicle rosters each broker keeps on file. MTM Health’s Virginia handbook (approved August 10, 2026) tracks license, training, background check, drug screen, and inspection dates. Letting that roster go stale can mean fewer trips, an improvement plan, and no payment for any trip a driver with lapsed documents performed.
• Broker relationships. Scorecard reviews with each broker’s field staff, improvement plans, incident reports, and answers to complaints.

Keep a short list of decisions that never leave the owner’s desk, whatever the manager’s title: signing provider agreements and rate changes, changing where payers deposit money, approving refunds and write-offs, buying insurance, and hiring or firing anyone at manager level. Keeping those is a basic control, not a sign of distrust. The internal controls guide shows how to split money duties in a small office.

Signs the owner has become the bottleneck

No regulation names a fleet size for this hire. The signal is that the owner’s own hours have become the ceiling on service. Watch for these:

• You are the supervisor on call every hour riders ride. Modivcare’s Mississippi manual (February 2024), for example, requires that the broker be able to reach a provider supervisor at all times members are in the provider’s vehicles. If that supervisor is always you, you cannot take a day off.
• The same scorecard misses keep coming back. Under MTM Health’s Virginia handbook, a field monitor goes over every metric with the provider at regular reviews. The standards include on-time performance above 95% and a trip re-route rate (trips handed back to MTM) under 0.5%. Providers below standard face an improvement plan, liquidated damages set by their service agreement, or termination. Hearing about the same miss at every review means nobody has time to fix the cause.
• Credentials lapse between audits. Under the same handbook, each expired credential on a driver or van that runs a trip costs two points, and three points shuts the provider out of the trip marketplace until the points come off.
• Tomorrow gets built at night. The owner still builds the next day’s runs after the last drop-off and returns trips close to the broker’s 24-hour turnback deadline.
• New work waits on your calendar. A facility contract or a second broker sits unsigned because nobody has time to credential and onboard.

Keep a one-week log before you decide. Write down every hour you spend on the five areas above. If they fill most of your week, the hire buys back the time the next stage of growth needs. The growth guide puts this hire at the stage when dispatch runs in two shifts and every driver complaint still ends up with the owner.

Medicaid treats the manager as a managing employee

An operations manager is usually a managing employee under Medicaid rules, and that means paperwork before the first day. Under 42 CFR 455.101, the label covers whoever runs or controls the daily operation, whatever the title (general manager, administrator, director) and whether or not the person is on your W-2 payroll. Three things follow:

1. Disclosure. The state Medicaid agency collects identifying details for every managing employee: name and address, plus the person’s Social Security number and date of birth (42 CFR 455.104(b)(4)).
2. Screening. The state checks managing employees against federal databases, including the HHS OIG exclusion list, and searches the exclusion lists at least monthly (42 CFR 455.436). Check the OIG exclusion list and your state’s exclusion list before the offer goes out.
3. Consequences. If the provider, an owner, an agent, or a managing employee leaves out information or sends it late or wrong, the state must deny or end the enrollment, unless the agency decides in writing that doing so is not in the program’s best interests (42 CFR 455.416(d)).

States set their own reporting deadlines. Two examples:

• Washington. The rule treats a managing employee as holding a control interest, and a provider must give the Medicaid agency written notice of any ownership or control change within seven calendar days (WAC 182-502-0018).
• Florida. A change in any principal, which includes a managing employee, goes to the state in writing within 30 days. Each managing employee also gets a Level 2 background screening through the state Medicaid agency (Florida Statutes 409.907(3)(k) and (8)(a)).

Brokers keep their own copy. MTM Health’s Virginia company profile lists the owner or manager by name, so update every broker portal the same week you report the change to the state.

What operations managers earn

Manager pay in the transit group that includes NEMT runs well below the national figure for the same titles. BLS estimates for May 2025 show the gap when you compare all private employers with NAICS 4859, the group that contains special needs transportation:

In NAICS 4859, BLS counted 2,660 general and operations managers, and the middle half earned $62,390 to $124,280 a year. The group is broader than NEMT. It pairs special needs transportation (NAICS 485991) with all other transit and ground passenger transportation (485999), so treat the median as a guide and check what local healthcare and logistics employers pay.

The supervisor row matters if you are deciding between a lead dispatcher and a true manager. A lead who runs the desk and the drivers costs closer to the supervisor figure. A manager who also owns broker relationships, vehicles, and credentials is the general and operations manager job. Either way, the employer also pays 6.2% Social Security tax on the first $184,500 of 2026 wages and 1.45% Medicare tax on all of it, per IRS Publication 15.

Salary or hourly: the executive exemption

A salaried manager skips overtime only if the job meets every part of the federal executive test in 29 CFR 541.100:

1. A salary of at least $684 a week, which is $35,568 a year.
2. A primary duty of managing the company or a recognized department of it.
3. Regular direction of the work of two or more other employees. That means two full-time people or the equivalent, such as one full-time and two half-time employees (29 CFR 541.104).
4. Authority to hire or fire, or recommendations on hiring, firing, and promotion that carry particular weight.

The $684 figure is the current one. In May 2026 the Department of Labor put the older regulatory text back in place after federal courts vacated the Department’s 2024 rule on these exemptions (91 FR 27833, effective May 15, 2026).

The trap in a small fleet is the working manager. Covering a shift or the phones now and then does not end the exemption by itself (29 CFR 541.106). The line is the primary duty: an employee whose main job is routine, recurring work is not an exempt executive just because they direct others when the boss is out. If your manager spends most days behind the wheel or on the dispatch line, pay hourly with overtime, or change the job first.

States can set a higher bar. California requires a monthly salary of at least twice the state minimum wage for full-time work (Labor Code 515). At the 2026 minimum of $16.90 an hour, that comes to $70,304 a year. The driver overtime guide covers the rules for the hourly staff the manager will supervise.

A 90-day handoff plan

Hand the job over in stages, so the manager learns each broker’s rules before owning the results. Here is one way to split the first three months.

Days 1 to 30: set up and learn

1. Report the managing employee change to your state Medicaid agency and update each broker’s company profile.
2. Run the exclusion searches and finish privacy training before the manager opens a rider record. HIPAA’s training standard reaches every new member of the workforce, within what the rule calls a reasonable period after they start (45 CFR 164.530(b)).
3. Give the manager a separate login for every broker portal and system. Never share the owner’s.
4. Sit at the dispatch desk for a full week, ride along with two drivers, and attend each broker’s next scorecard review together.
5. Read every broker manual you work under and list each deadline: turnback notice, will-call response, incident reports, and credential renewals.

Days 31 to 60: take over the service

1. The manager builds and approves driver schedules and handles call-outs.
2. Dispatchers and drivers report to the manager, and coaching and discipline go through them.
3. The manager owns the incident process and files broker reports on time.
4. A weekly review of late trips, returned trips, and complaints starts. The dispatcher performance metrics guide lists the office measures to use.

Days 61 to 90: take over the scorecard

1. The manager meets broker field staff without the owner and answers for the numbers.
2. The manager keeps the credential calendar and the vehicle maintenance schedule.
3. The owner moves to one weekly meeting covering the scorecard, open problems, hires, and spending above an agreed limit.

On day 90, put on-time results, returned trips, complaints, and your own weekly hours next to the week-one log. If none of the four has moved, list the tasks you are still holding before you judge the hire.

If the manager will also serve as your compliance contact, keep billing in someone else’s hands. HHS OIG’s compliance guidance for small entities describes a compliance contact who, where possible, has no part in billing, coding, or claims, and who briefs the owner on compliance work at least once a quarter. The compliance program guide covers the rest of that role.

Handing a manager the full picture

In HealthRide, the new manager sees only what their role allows, and every change on the account is recorded. Reminders go out before driver and vehicle credentials expire, which keeps rosters current between broker audits. The reports cover on-time results, driver activity, and timecards, so the weekly meeting starts from the numbers the manager answers for.