Consulting
Fractional COO Services for Medical and Behavioral Health Practices
A full-time medical and health services manager in the Miami metro area earned a mean $142,100 a year in May 2025, before benefits (BLS). Our fractional COO services provide executive-level operational leadership and oversight instead: day-to-day operations, KPIs, SOPs and staff accountability, within the limits you set in writing.
The short answer
What do fractional COO services include?
Executive-level leadership and oversight of your day-to-day operations, KPIs, SOPs and staff accountability, within limits you put in writing before the COO starts. A full-time manager at the Miami mean wage costs about $184,000 a year with benefits (our estimate from BLS data). The Advixor Group's fractional COO directs, coordinates, implements and oversees within the authority you delegate; you keep ownership and the final call.
SourcesBLS wage estimates, May 2025BLS employer costs, table 4
What We Do
What does a fractional COO do for a medical or behavioral health practice?
Our operational efficiency projects are consultative and project-based: ongoing executive management and day-to-day oversight come only with the fractional COO service.
Fractional COO services
Beyond the six areas listed under “What our fractional COO consulting includes”, our fractional COO:
- Joins your leadership and management meetings as needed, sets priorities, action items, owners and deadlines, and follows them up
- Does the executive-level problem solving, analysis and decision support behind operational calls
- Coordinates work across departments, and with your outside professionals when a matter needs them
Delegation
Fractional COO services: what you delegate and what you keep
Our COO directs, coordinates, implements and oversees within the authority you delegate; you keep ownership, governance and the final call on business, financial, employment, clinical and legal decisions. Unless you authorize it in writing, the COO has no authority to:
- sign contracts or take on financial obligations;
- access or transfer your funds;
- hire or terminate employees, or change anyone’s pay;
- otherwise legally bind the practice.
The service doesn’t replace legal, accounting, medical or other licensed work: clinical decisions that need a license stay with a licensed professional (clinical supervision is a separate service), and legal questions go to your own attorney.
Rates
Fractional COO rates and what a full-time manager costs
Our fractional COO fee depends on the hours and the scope your practice needs. We go over your needs first, then put the fee, the hours a month and the term in writing.
BLS publishes no wage series for fractional executives, so the benchmark is the full-time job. Its May 2025 survey counts 597,080 medical and health services managers nationally (median $123,860) and 12,290 in the Miami-Fort Lauderdale-West Palm Beach area (median $128,770).
In the Miami metro area, 8 in 10 of these managers earn between $75,870 and $219,200; in physicians’ offices nationally, the median is $105,770 and the top tenth earns $274,990 or more. Benefits come on top: in June 2026 they were 32.5% of private employers’ compensation costs for management, business and financial occupations, 9.6 points of it paid leave, which an annual salary already covers.
Source BLS, Occupational Employment and Wage Statistics, May 2025 (read Oct 19, 2026).
Side by Side
Hire a fractional COO or a full-time manager: side by side
| Full-time manager (your W-2 employee) | Fractional COO (under contract) | |
|---|---|---|
| Yearly cost | About $184,000 with benefits at the Miami mean wage; $183,000 at the national mean (estimates) | The fee in your engagement agreement |
| Medicare delegated official | Can be one, as a W-2 managing employee | Only with an ownership or control interest |
| Florida Level 2 screening | Administrator or financial officer of an AHCA licensee; any Medicaid principal | The same: the statutes name the role, not how it is paid |
| Exclusion | An excluded person may not hold an executive or leadership role | The same: CMS’s denial rule names contracted individuals |
| Authority | Your employment terms and governing documents | What your engagement agreement delegates |
Sources BLS OEWS (May 2025) and ECEC (June 2026; estimate = mean wage ÷ 77.1%, the share of compensation paid as wages and paid leave, both already in an annual salary); 42 CFR 424.502 and 424.530(a)(2); ss. 408.809 and 409.907, F.S.; HHS-OIG bulletin (May 8, 2013).
Medicare
A fractional COO under contract: how Medicare lists the role
Medicare’s managing employee is anyone with operational or managerial control over the practice’s day-to-day operation, “either under contract or through some other arrangement, whether or not the individual is a W-2 employee” (42 CFR 424.502). Every CMS-855B (12/2025) filer needs at least one owner, one managing employee and one authorized official, and section 6 asks whether each managing employee is W-2 or contracted.
Your authorized official can name delegated officials to update your enrollment record, within a limit set in the same section.
Physicians, nonphysician practitioners and their organizations report a change of ownership, an adverse legal action or a practice-location change within 30 days, and “all other changes in enrollment” within 90 days (42 CFR 424.516(d)). How each change is filed: Medicare enrollment.
Who can be a delegated official
“The delegated official must be an individual with ownership or control interest in, or be a W-2 managing employee of the provider or supplier.”
Florida
Fractional COO for hire in Florida: screening and reporting
- Florida Medicaid. A provider’s principals include any managing employee. Each gets Level 2 background screening through AHCA, and a change in any principal is reported “to the agency in writing within 30 days after the change occurs” (s. 409.907(3)(k), (8)(a)2., F.S.; Florida Medicaid enrollment).
- AHCA-licensed providers. Level 2 covers the administrator “responsible for the day-to-day operation of the provider” and the financial officer (s. 408.809(1)(b)–(c)), and changes to your latest license application are due within 21 calendar days (s. 408.810(3)). See AHCA licensing and Level 2 background screening.
Which of these roles, and whether your COO is a managing employee or can be a delegated official on your Medicare file, is a question for your attorney.
Before You Sign
What to ask fractional COO companies before you sign
- Who will the COO be, and with what operations background?
- Is the COO the firm’s employee or a contractor, and how will the role appear on your CMS-855B and Medicaid file?
- Has the COO been checked against the OIG exclusion list, and how often will that repeat?
- Does the role trigger Level 2 screening, and who arranges it?
- What can the COO sign, spend, hire or change, and where is that written?
- What are the fee, monthly hours and minimum term, and how does the engagement end?
- What professional liability coverage does the firm carry?
We answer every one of these before you sign anything. Put the same seven questions to us when you contact us.
What’s included
What our fractional COO consulting includes
Practice management
Oversight and coordination of day-to-day business activities, with periodic reports to ownership.
Learn moreOperational efficiency
Operational policies, procedures, SOPs and internal processes, put in place and monitored.
Learn moreHealthcare KPIs
Which key performance indicators to track, and how each one is measured.
Learn moreHR and staff training
Structure, reporting lines, roles and performance expectations for staff and managers.
Learn moreBusiness development
Operational planning for growth, expansion and restructuring you approve.
Learn moreCompliance
Operational inefficiencies, workflow issues and organizational risks, identified and resolved.
Learn moreQuick answers
Fractional COO services: rates, exclusion checks and hiring
What the title means, an hourly benchmark, coaching, exclusion checks and when a full-time hire fits. Raise anything specific to your practice in a consultation.
What is a fractional COO?
What is a fractional COO's hourly rate?
Is a fractional COO the same as an executive coach?
Before I hire a fractional COO consultant, do I check the exclusion list?
Do I need a fractional COO, or a full-time hire?
Talk to an advisor
You care for patients. Who’s taking care of the business?
Tell us where your practice is today. We will tell you what we would do first.
Official sources
- BLS, read Oct 19, 2026: Occupational Employment and Wage Statistics tables (May 2025 estimates), Employer Costs for Employee Compensation, table 4 (June 2026), Occupational Outlook Handbook: Medical and Health Services Managers (Aug 27, 2026) and the Public Data API
- eCFR (current as of Oct 15, 2026), read Oct 19, 2026: 42 CFR 424.502, 424.516 and 424.530
- CMS, CMS-855B Medicare enrollment application (12/2025), sections 6 and 15, read Oct 19, 2026
- Florida Statutes (2026), read Oct 19, 2026: s. 400.9935, s. 408.809, s. 408.810 and s. 409.907
- HHS-OIG, Special Advisory Bulletin on the Effect of Exclusion (May 8, 2013), read Oct 19, 2026