Construction Cost Manager, US Operations & Markets • New York • Full time • Hybrid Construction Cost Manager, US Operations & Markets • New York • Full time • Hybrid

Neko is redefining what prevention means, from treating illness when it arrives, to sustaining health before it's ever at risk. Our mission: make data-driven, preventative care accessible to more people, before symptoms appear.
In a single, non-invasive visit under an hour, proprietary technology and direct clinical care combine to deliver personalised, actionable insights. It's a team that thinks in 10x, not 10%. Every role here plays a part in building a world where prevention is the norm, and where your work genuinely helps people live longer, healthier lives.

Role Purpose

We are seeking a highly motivated and detail-oriented senior professional to join the growing Neko Health team as our Construction Cost Lead/Senior Estimator for the US. In this crucial role, you will lead commercial management of Neko Health's construction program across US markets, responsible for cost planning, procurement, and commercial control of the build-out of a high-precision healthcare experience that meets stringent technical, operational, and regulatory expectations. This is a unique opportunity to shape the future of healthcare delivery by ensuring best-in-class cost management and commercial governance. The role requires someone with 10+ years of experience in construction cost management, strong analytical skills, deep estimating and preconstruction expertise, high autonomy, high accountability, and experience working across multiple US markets.

What You'll Deliver in the First 6–12 Months

Cost management and commercial control

Establish a US cost benchmarking database and vendor ecosystem (general contractors, MEP trades, millwork, design consultants) with rates benchmarked across markets and measurable commercial SLAs.

Own the end-to-end cost management of Neko Health centers across the US, from feasibility budgets and conceptual estimates through final reconciliation and project closeout, ensuring each site is delivered within budget without compromising the precision, safety, and design standards required for our scanning technology.

Develop and maintain cost plans, quantity takeoffs, bid analyses, schedules of values, progress payment applications, change orders, and cost-to-complete reports, while effectively managing commercial risks and contingencies.

Conduct regular site visits to verify work in place for progress payments, identify commercial risks and variations, and challenge contractor claims where appropriate.

Support design excellence by working closely with the Locations Design Manager and Project Managers, providing cost advice and value engineering options to inform design decisions and protect the budget.

Lead the commercial administration of construction contracts (e.g., AIA A101/A201, ConsensusDocs, or owner-form agreements) including change orders, claims, time extensions, and project closeout.

Track and report on commercial KPIs including cost performance against budget, cash flow, committed vs. forecast spend, and savings from value engineering.

Feasibility and preconstruction

Produce feasibility budgets and order-of-magnitude (ROM / AACE Class 4–5) estimates for potential sites across US markets to inform leasing decisions.

Identify and communicate commercial risks that may affect leasing terms, budget, or project timelines, including landlord work letters and tenant improvement allowances, restoration obligations, and base-building condition exposure.

Lead the bid process for vendors and general contractors, including preparing bid documentation, issuing invitations to bid, leveling returns, and producing bid recommendation reports.

Strategic and operational alignment

Collaborate with in-house and external design teams to provide cost input at each design stage (SD, DD, CD) and ensure designs remain within budget.

Drive value engineering and life-cycle cost analysis to deliver cost-effective solutions while maintaining high-quality standards.

Lead the effort to build a clear cost playbook, standardize commercial rates for space types, and train contractors and vendors on using established work breakdown structures (CSI MasterFormat / UniFormat).

Support preconstruction efforts across US markets including test-fit pricing, feasibility estimates, and budget validation in partnership with local consultants.

Develop and maintain commercial documentation, including cost reports, commercial risk registers, change logs, and stakeholder reports.

Capture and analyze cost data from completed projects to refine benchmarks and inform future feasibility estimates.

Minimum Qualifications

10+ years of proven experience as a Cost Manager, Senior Estimator, or Preconstruction Manager (consultancy or owner/client-side), preferably in healthcare, retail, or a related fit-out industry. AACE (CCP/CEP), ASPE (CPE), or equivalent certification preferred; degree in Construction Management, Engineering, or Quantity Surveying.

Experience supporting growing organizations, with a track record of commercial management of prestigious projects.

Strong understanding of interior fit-out construction, US cost methodologies and estimate classes (CSI MasterFormat, UniFormat, AACE Class 1–5), and standard forms of contract used across US markets (e.g., AIA A101/A201, ConsensusDocs, lump sum, GMP, design-build).

Excellent problem-solving and decision-making skills with the ability to effectively collaborate with diverse teams and stakeholders.

Experience working with cross-functional teams and managing projects across multiple US jurisdictions, including familiarity with regional labor markets, prevailing wage considerations, and permitting variations.

High adaptability and ability to work in a fast-paced, evolving environment.

Excellent written and verbal communication skills in English.