How to Hire a Nursing Home Administrator
A nursing home cannot operate without a licensed Administrator — CMS requires one by name. Here is what the licensing process actually involves, what the role owns day to day, and a job description and posting template you can use as-is.
Quick answer
Every CMS-certified nursing home must employ a licensed Administrator under 42 CFR §483.70(d). Licensure requires a bachelor's degree in most states, an Administrator-in-Training program (1,000-2,000 supervised hours), and passing the national NAB exam — plus a separate state exam in some states. The Administrator owns overall operations, regulatory compliance, and is the facility's primary point of contact during survey.
Why this hire is non-negotiable
Unlike most senior hires, this one is a federal requirement, not a business decision. 42 CFR §483.70(d) requires every Medicare- and Medicaid-certified nursing home to employ a licensed Administrator, and every state is federally required (42 CFR Part 431, Subpart N) to maintain its own Nursing Home Administrators Board to license them. A facility without one is out of compliance from day one.
The licensing path, step by step
Education
Most states require a bachelor's degree at minimum. Many candidates hold degrees in healthcare administration, business, or a related field.
Administrator-in-Training (AIT) program
A supervised training period under a licensed administrator — typically 1,000 to 2,000 hours depending on the state — covering operations, finance, human resources, and resident care.
NAB licensure examination
A 150-question, computer-based national exam covering management and administration, finance, human resources, and resident care, with a three-hour time limit and a passing scale score of 113.
State exam (in some states)
Several states — California and Maryland among them — require an additional state-specific exam on top of the national NAB exam. Others, like Virginia, require only the national exam. Confirm the requirement in the facility's own state before starting a search.
State licensure and biennial renewal
Once licensed, Administrators typically renew every two years with 30-40 hours of continuing education per cycle — requirements set by the state Nursing Home Administrators Board, which every state is federally required to maintain.
What the role actually owns
- Overall facility operations, budget, and regulatory compliance across every CMS-mandated program
- Hiring, supervising, and evaluating department heads, including the Director of Nursing
- Serving as the facility's primary point of contact during a CMS or state survey
- Ensuring the facility maintains substantial compliance and responding to any Statement of Deficiencies within the 10-day Plan of Correction window
- Managing the relationship with the governing body, ownership, and — where applicable — a management company or chain
Job description & posting template
The support a new Administrator inherits with PoC360
A new Administrator walking into an unfamiliar facility inherits its entire compliance history on day one. PoC360 gives them a single view of open citations, active Plans of Correction, and every CMS-mandated program's status — so ramp-up starts from a real picture, not a filing cabinet.
Start Free Trial →Frequently Asked Questions
Does CMS require a nursing home to have a licensed Administrator?+
Yes. Federal regulation at 42 CFR §483.70(d) requires every Medicare- and Medicaid-certified nursing home to employ a licensed Administrator, and 42 CFR Part 431, Subpart N requires every state to maintain a Nursing Home Administrators Board to handle that licensing.
What is the NAB exam?+
The National Association of Long Term Care Administrator Boards (NAB) licensure exam — a 150-question, computer-based test covering management and administration, finance, human resources, and resident care, with a three-hour time limit and a passing scale score of 113.
How long does it take to become a licensed nursing home Administrator?+
It varies by state, but typically includes a bachelor's degree, an Administrator-in-Training program of 1,000 to 2,000 supervised hours, and passing the NAB exam (plus a state exam in some states) — a process that commonly takes a year or more before someone is eligible to lead a facility independently.
Do all states require the same Administrator licensing process?+
No. All states require the national NAB exam, but some — California and Maryland among them — also require a separate state exam, while others, like Virginia, require only the national exam. Always confirm the specific state's requirements before starting a search.