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Fractional CEO & COO Leadership

Steady the Program, Then Grow It

When a program is under census pressure, losing revenue it should be collecting, or running without the senior leadership it needs, the answer is rarely another marketing campaign, it's an operational one. Pacific Crest steps in as your fractional CEO or COO to stabilize what's broken, rebuild the systems underneath admissions and revenue, and put the program on footing solid enough to grow, led by someone who has actually done the job from the inside.

Start the Conversation The Admissions Focus

Marketing Fills the Pipeline, but Operations Decides What Happens Next

Marketing brings families to the door. Operations determines whether they're admitted, whether they stay in care, and whether the treatment you deliver actually gets paid for. When those systems are weak, more leads just means more admissions slipping through the cracks.

Most programs under pressure don't have an isolated marketing problem, they have an operational one, whether that's a leaky admissions process, a revenue cycle that loses money, or a team without senior direction, and no amount of ad spend can outrun it.

Our Approach

Census Pressure Is Almost Always Downstream

When admissions are soft, the instinct is to buy more leads, yet in most programs the leads are already arriving and simply being lost somewhere between the first call and a collected admission, which is an operational failure, and a fixable one.

The Leads Are Already There

Most programs generating any marketing at all have more inquiries than they convert. Calls go unanswered, follow-up is slow, and families in crisis move on to the program that picked up first. Fixing the operation recovers admissions you're already paying to generate.

The Caller Is Rarely the Client

In behavioral healthcare, the path to admission runs through family members, referring clinicians, interventionists, and insurance coordinators, so an admissions process designed for a simple lead form falls apart against that complexity, and the system has to account for how families actually decide.

Billed Revenue Isn't Collected Revenue

A program can look busy and still lose money if utilization review, benefits verification, and the revenue cycle are leaking, so operational leadership means watching the gap between what you bill and what you actually collect, and then closing it.

Leadership Gaps Compound

When a program lacks a seasoned CEO or COO, or has one stretched too thin to go deep on any of it, small operational problems accumulate into census decline, and a fractional operator puts senior judgment in the room without the cost of a full-time executive hire.

Why This Is Different

I've Carried the Census Myself

Most people offering to fix your operation have never run one, and I have run several. I was the founding hire at a residential treatment center and helped scale it to seven times its original census across operations, admissions, and marketing, then founded and operated my own high-acuity adolescent residential program, growing census from zero and living the revenue cycle firsthand. I later led growth for a PE-backed, multi-state platform, where the work was as much operational discipline as it was demand generation.

You get a fractional operator who has actually held the CEO and COO roles in this exact industry, stepping into your program to do the work rather than advise on it from the sidelines.

That background is why the diagnosis usually lands on operations rather than marketing, because once you've had to make payroll against a soft census month, you learn fast where programs actually leak, and how to stop it.

Where Census Is Won or Lost

Admissions Team & Systems Development

More census is lost inside the admissions process than anywhere else in a behavioral healthcare program, whether it's a missed call, a slow follow-up, an intake coordinator who can't speak to the clinical model, or a CRM that no one trusts, and every one of those quietly costs admissions that marketing already paid to generate. Getting this function right is the work I focus on most.

Building the Team

Hiring, structuring, and training admissions and intake staff on call handling, clinical fluency, and scripts that reflect the program's actual positioning, so the first conversation a family has matches the brand that brought them in.

The Systems Underneath

CRM setup and discipline, lead routing, speed-to-lead, follow-up cadence, and reporting that makes the pipeline visible, all of the infrastructure that ensures no inquiry falls through the cracks.

Process & Accountability

Clear SLAs, conversion tracking from inquiry to admit, and a benefits and UR workflow, so that admissions runs on a defined process with real accountability rather than on whoever happens to answer the phone.

QA & Coaching

Call review, quality assurance, and ongoing coaching that steadily lifts conversion, which is the difference between a team that only takes calls and a team that actually admits.

This is the highest-leverage operational work in most programs. Fix admissions, and the marketing you're already running starts converting at a rate that changes the census.

The Full Scope

Where a Fractional Operator Steps In

Interim & Turnaround Leadership

  • Step into a CEO or COO gap on an interim basis
  • Triage the operational issues driving census or margin decline
  • Bring senior decision-making to a leadership team stretched too thin
  • Identify the operational failure points behind soft census or collections
  • Rebuild the processes and accountability that stabilize the program
  • Create a clear path from stabilization to growth

Census & Admissions Operations

  • Map the full path from first inquiry to collected admission
  • Find where calls, follow-up, and handoffs break down
  • Quantify the census being lost inside the process
  • Team structure, training, and QA
  • CRM, routing, and speed-to-lead systems
  • Conversion tracking and accountability from inquiry to admit

Revenue Cycle & Payor Strategy

  • Review benefits verification, utilization review, and the revenue cycle
  • Identify where revenue is leaking
  • Assess payor mix and reimbursement reality
  • Tighten UR and documentation workflows
  • Align admissions criteria to payor and clinical fit
  • Build reporting that keeps collected revenue visible

Org Design, Staffing & PE/M&A Readiness

  • Define the leadership structure the program actually needs
  • Identify staffing gaps and hiring priorities
  • Build the operational infrastructure to support growth
  • Get operational and financial reporting into diligence-ready shape
  • Address the operational risks investors will scrutinize
  • Position the program for a raise, sale, or platform roll-up

Every engagement starts with an operational diagnostic, because before recommending anything I need to understand your census trends, admissions process, revenue cycle, and leadership structure, and where the real leak actually is. That conversation shapes everything that follows.

Deliverables

What You Get

Operational Diagnostic

A clear-eyed assessment of where census and margin are actually being lost, whether in admissions, the revenue cycle, leadership, or process, which is where every other decision starts.

Admissions Systems Build

Team structure, training, CRM and routing systems, and a defined process from inquiry to admit, the engine that converts the leads you already have.

Revenue Cycle Assessment

A map of the gap between billed and collected revenue, with a plan to close it across benefits, utilization review, and documentation.

Leadership & Org Structure Plan

The leadership structure, staffing priorities, and operational infrastructure the program needs to stabilize and grow.

Interim Leadership Coverage

Senior CEO or COO capacity in the room on a fractional or interim basis, without a full-time executive hire.

Stabilization & Growth Roadmap

A sequenced plan that moves the program from steadying the operation to being positioned to grow.

Is the Problem Really Marketing, or Is It Operations?

Start the Conversation
What Operators Need to Know

Before You Engage

All three. I step in on an interim basis to cover a leadership gap, stay on as an ongoing fractional CEO or COO, or take a defined project like an admissions rebuild with a clean handoff. The structure follows the need.

A consultant hands you a deck and a set of recommendations, whereas a fractional operator does the work, taking on the leadership role, owning the outcome, and staying accountable to census and collected revenue. I've run these programs myself, so I operate rather than just advise.

Rarely, because most often I work alongside your existing team, filling a gap, adding senior capacity, or leading a specific function like admissions while your clinical and operational leaders keep doing what they do well.

Operations and marketing are two sides of the same growth problem, because once the operation reliably converts and collects, marketing compounds instead of leaking away, and when you need both at once, I lead them together.

Get Started

Every Program Is Different.
Let's Find What Yours
Actually Needs.

Every engagement starts with a straight conversation about where you are, where you want to go, and whether we're the right fit. No pitch deck. No pressure.

  • Initial consultation is always complimentary
  • Limited client roster by design
  • Focused on behavioral healthcare
  • Direct access to operator-level expertise

Prefer to talk?
info@pacificcrestgrowth.com  |  917-662-7192