Medical and Health Services Manager Career Assessment

2What is a Medical and Health Services Manager?

A medical and health services manager makes a health care operation work so that the clinical people can do their jobs. You build the schedule and you fill the holes in it when three people call in. You watch the budget and you know what every position costs. You know the rules — state licensing rules, federal Medicare and Medicaid rules, accreditation standards, privacy rules — and you are the one who gets asked why something was not documented. You hire nurses and aides in a state that does not have enough of either. When a surveyor walks in the door unannounced, you are the person who walks with them. In a small ND critical access hospital you may run four departments at once. In a big system you run one clinic or one unit and report to a director above you.

The Reality: Read this part twice. In North Dakota this is usually a promotion, not a hire. The most common road here is clinical: a nurse becomes a charge nurse, then a unit or clinic manager, then a director. Others come up through clinic operations — front desk, scheduling, billing, office coordinator, practice manager. A health administration degree helps, and it helps more every year, but a degree with no health care history behind it will lose to an experienced charge nurse almost every time, because the staff have to believe you understand what their day is like. The second honest thing: you are the buffer. Patients and families are upset, staff are short, and the regulator does not care that you were short. You absorb all of that and you still have to keep people from quitting.

Your Responsibilities:

• Build the staffing schedule and cover it when people call in sick
• Hire, train, coach, and keep nurses, aides, techs, and front office staff
• Manage the budget and explain what each position and supply costs
• Keep the operation ready for state surveys and accreditation visits
• Know and follow Medicare, Medicaid, privacy, and state licensing rules
• Handle patient and family complaints that clinical staff cannot resolve
• Track quality measures, infection rates, wait times, and readmissions
• Work with doctors, nurses, billing, and the people above you on what changes next

You keep the place running so the care can happen.

3A Day in the Life

6:45 AM — Check the overnight messages. Two aides called off for day shift and one for night.

7:15 AM — Rework the schedule. Call three people. Pick up part of a shift yourself if you still hold a license.

8:30 AM — Morning huddle with charge nurses. Census is up, two admissions coming.

10:00 AM — A family is upset about their mother’s care. Sit down with them for forty minutes and listen first.

11:30 AM — Budget meeting. Overtime is over target again and you have to explain why.

1:00 PM — Interview a nurse candidate. There is exactly one applicant for the opening.

2:30 PM — Pull chart documentation for a quality measure before the survey window opens.

4:30 PM — Write tomorrow’s staffing plan. Your phone stays on tonight.

Short-staffed, interrupted, and always one survey away from a hard week.

4Training in North Dakota

Most people here come up from the clinical or clinic-operations side. A degree speeds it up. There is no single required credential for most of these jobs — but nursing home administrators in North Dakota are licensed, and that is a real, separate requirement. For the rest, what employers want is health care experience plus proof you can run a schedule, a budget, and a survey. Many ND managers hold a clinical license and added a business or health administration degree while working. Others went the other way and learned the clinical world from the front desk out.

Training Pathways:

• Clinical to management (5 to 10 years): Work as a nurse, therapist, tech, or aide. Take the charge role. Then the unit or clinic manager job. This is the most common road in North Dakota, and it is the one hiring managers trust most.
• Clinic operations upward (5 to 10 years): Front desk, scheduling, medical records, billing and coding, then office coordinator, then practice manager. This road gets you the money and rules side first, and the clinical understanding comes from being in the building every day.
• Degree while you work (2 to 4 years): A business or health administration degree, most of them available online in North Dakota, is what moves you from managing one clinic to running several — or out of a small town and into a system job. It is also how people with no clinical license stay competitive.

Where to Train in North Dakota:

• University of North Dakota (Grand Forks) — Master of Public Health, 42 credits, fully online with no campus visits, with a Health Management & Policy specialization built for managing health delivery systems; accredited by the Council on Education for Public Health (und.edu/programs/public-health-mph)
• University of North Dakota (Grand Forks) — a Health Administration certificate and a Master of Public Administration accredited by NASPAA, both through the Nistler College of Business & Public Administration, useful for the public and non-profit side of health care (business.und.edu/academics)
• University of Mary (Bismarck) — online MSN/MBA dual degree in health care administration, plus an MBA, a Master of Organizational Leadership, and BSN-to-MSN tracks in Nursing Leadership & Management and in Nursing and Health Care Informatics (online.umary.edu/academics/masters-doctoral-programs)
• University of Mary (Bismarck) — a graduate certificate in Human Resources Management that applies toward either the MBA or the Master of Organizational Leadership, both online, since staffing is most of this job (online.umary.edu/academics/business)
• North Dakota State University (Fargo) — Management B.S. and Business Administration B.S., both available 100% online, for the business half of the job (ndsu.edu/business/academic-programs/undergraduate)
• Minot State University (Minot) — Management B.S. and a Master of Science in Management, plus graduate certificates in Leadership Studies (minotstateu.edu/business)
• Bismarck State College (Bismarck) — Management AAS and the Leadership certificate, online or on campus, with no prior coursework required, as an affordable first step that stacks toward a bachelor’s (catalog.bismarckstate.edu/catalog/degrees/career-technical-education/management)
• ND State College of Science (Wahpeton and Fargo) — Business Management AAS; the Business Technology Management option is a third year for people who already hold a two-year technical degree and includes human resource management coursework (catalog.ndscs.edu/business-management)

Before You Start: Health care experience of some kind is close to required in practice. If you hold a clinical license, keep it current. Comfort with spreadsheets, because you will live in a staffing grid and a budget. Patience with rules, because there are a great many of them.

Tip: Start with financial aid, scholarships, and any help an employer offers — that is where the money starts. After that, ask a career counselor or Job Service North Dakota whether WIOA or other programs can help with what is left over, like training, tools, work boots, or exam fees. What can be paid for depends on the program and on your own situation, so ask before you sign up rather than after. Registered apprenticeships let you earn a paycheck while you learn — see jobsnd.com/job-seeker/apprenticeships for ND programs.

5Certification & Licensing

Nursing home administrators must be licensed in North Dakota. Most other jobs here are not licensed. If you want to run a nursing home in this state, the North Dakota Board of Examiners for Nursing Home Administrators licenses you and you cannot do the job without it. For clinic, hospital department, home health, and behavioral health management there is no state license for the manager job itself — but many managers hold a clinical license from their earlier career, and the national FACHE credential is the recognized mark for senior health care leaders.

What Counts in Health Care Management:

• ND Nursing Home Administrator license — required to run a nursing home here. The board requires you to be at least 18 and of good moral character, and to hold a bachelor’s degree, or an associate degree plus at least five years of licensed nursing home administrator practice in the last six. There is a board-approved administrator-in-training path, and a nonrefundable $250 application fee (ndnha.nd.gov/licensure-requirements)
• The two nursing home exams — the national NAB exam, which is the CORE exam plus the Nursing Home Administrator line-of-service exam, registered and paid for directly through NAB, and a North Dakota state exam on state law and rules that the board says is open book and offered at no cost (ndnha.nd.gov/licensure-requirements/required-exams-licensure)
• FACHE from ACHE — the senior credential in health care management. ACHE requires one year of ACHE membership, a master’s or other post-baccalaureate degree, a current healthcare management position with five years of healthcare management experience, 36 continuing education credits in the past three years, four volunteer activities (two civic and two in healthcare) in the past three years, and two references including an interview with a current Fellow. Then you pass the Board of Governors Exam within two years of approval. ACHE publishes a $250 nonrefundable application fee and a $225 exam fee (ache.org/fache/earn-my-fache)
• Your own clinical license — an RN, LPN, therapy, or social work license from your earlier career is the single most useful thing on your resume for ND clinical management jobs, and it is worth keeping current even after you stop practicing
• A master’s degree — health administration, public health, business, or nursing leadership. Not required for most ND jobs, and close to required for system-level ones

The Exams: Only the nursing home administrator road has required exams in North Dakota: the NAB CORE and NHA line-of-service exams plus the open-book state exam. FACHE has the Board of Governors Exam, which is national and voluntary.

Cost: The ND nursing home administrator application fee is $250 and nonrefundable, and the board says the criminal history record check cost is yours. NAB sets and collects its own exam fees, so check NAB’s site for those. The ND state exam is free. ACHE publishes $250 for the Fellow application and $225 for the Board of Governors Exam. Ask your employer whether they pay for any of it — health systems very often do.

Keeping It Current: ND nursing home administrator licenses renew on the board’s schedule with continuing education. FACHE recertification requires 36 continuing education credits within three years. Any clinical license you hold renews on its own board’s schedule.

6Salary & Job Outlook

North Dakota Medical and Health Services Manager Pay (May 2025):

• Starting out (bottom 10–25%): $37.57–$43.01/hour ($78,150–$89,460/year)
• Middle (median — half earn more, half earn less): $50.56/hour ($105,170/year)
• Experienced (top 25–10%): $64.17–$86.42/hour ($133,470–$179,740/year)

What that means: The middle medical and health services manager in North Dakota earns about $105,170 a year, against a national middle of about $123,860. That is a real gap — about $18,700 — and it is worth knowing. But look at the bottom end: the ND tenth percentile is about $78,150 while the national tenth percentile is about $73,390. North Dakota pays its entry-level health managers better than the country does, and pays its top ones less. That is what a state without big hospital headquarters looks like. The ND top tenth is about $179,740, which is a very good living here, and the spread between the bottom and the top of this job mostly tracks the size of what you run: one clinic, one department, a nursing home, or a whole rural hospital.

Jobs in North Dakota: About 920 people do this work in ND today. By 2034, that should be about 1,160 (about 25% growth). Expect about 100 job openings every year in ND from growth and people retiring or changing jobs. Across the U.S., the change is about 23% growth — much faster than average.

Outlook: Excellent, and the best growth rate of any job in this series. O*NET shows North Dakota going from about 920 medical and health services managers in 2024 to about 1,160 in 2034 — about 25% growth, with roughly 100 openings a year. Nationally the job grows about 23%, which BLS calls much faster than average, so ND is growing it even a little faster than the country. The reason is plain: North Dakota is getting older, rural hospitals and nursing homes are under real strain, and every one of them needs somebody to run it. Openings show up in Fargo, Bismarck, Grand Forks, and Minot, but also in small-town critical access hospitals, clinics, and long-term care facilities all over the state — and those small-town jobs are the ones that go unfilled longest, which is an opportunity if you are willing to live there.

Who Hires in ND: Sanford, Essentia, Altru, CHI St. Alexius and the other ND health systems; critical access hospitals in small towns; nursing homes and assisted living facilities; physician clinics and dental and eye practices; home health and hospice agencies; behavioral health and addiction treatment programs; public health units; the Indian Health Service and tribal health programs; and insurers and billing companies.

Work Setting: A hospital, a clinic, or a long-term care building. You are inside, on your feet more than you expect, walking units and offices all day. Usually 45 to 55 hours a week. You carry a phone, and in a nursing home or a hospital you are called at night and on weekends because the building never closes. Small-town jobs mean fewer people to hand things to.

Physical Demands: Low to moderate. Mostly walking and standing, not lifting. What actually wears people out in this job is emotional, not physical: short staffing that never fully resolves, families in the worst week of their lives, and knowing that a survey finding lands on you. If you still carry a clinical license, you may end up working a shift on the floor when nobody else can.

Sources: U.S. Bureau of Labor Statistics, Occupational Employment and Wage Statistics, North Dakota, May 2025 (SOC 11-9111); North Dakota and U.S. long-term employment projections 2024–2034, via O*NET OnLine. Numbers are rounded.

7Where This Leads

Path 1: Front-line clinical or clinic staff — Nurse, aide, tech, therapist, front desk, scheduler, biller. Everybody starts somewhere in the building.

Path 2: Charge Nurse or Office Coordinator — You run the shift or the front office. This is the first real test.

Path 3: Clinic Manager or Unit Manager — One clinic or one unit is yours — schedule, budget, staff, and complaints.

Path 4: Nursing Home Administrator — A licensed role. The whole building, the residents, the survey, and the budget.

Path 5: Director of Nursing or Director of Operations — Several units or several clinics, and the managers running them.

Path 6: Chief Operating Officer or Hospital Administrator — You run the facility. This is where a master’s degree and FACHE start to matter.

8The Real Talk

What's Great:

• About 25% growth and roughly 100 ND openings a year — the fastest-growing job in this series
• You can get here from nursing, therapy, or the front office without starting over
• Even the bottom tenth earns about $78,150, above the national bottom for this job
• Every town in North Dakota with a clinic or a nursing home needs someone in this role
• The work matters in a way you can see on people’s faces
• Real ladder above you, all the way to running a hospital

What's Hard:

• Short staffing is the permanent condition, not a temporary problem
• The survey can come any day and the findings are yours
• Upset families and grieving families, regularly
• ND pay runs about $18,700 below the national middle
• You are on call because the building never closes
• You will have to tell good people no when the budget says no

Be Honest: Can you stay calm with a family who is furious and frightened at the same time? Can you keep rebuilding a schedule that keeps falling apart and not take it home? Can you learn rules you did not write and enforce them on people you like? And are you willing to start on the floor or at the front desk, because in North Dakota that is where nearly every one of these managers started?

9Part 1: What Attracts You?

10Part 2: Are You Ready?

11Part 3: Your Next Move

Your Medical and Health Services Manager Assessment Results