Operating room (OR) scheduling and management represent a critical intersection of clinical care, operational logistics, and financial stewardship. This chapter explores how anesthesiologists—uniquely positioned at the center of perioperative systems—can leverage governance structures, economic principles, and technology to optimize efficiency while preserving safety and satisfaction. It reviews the financial foundations of OR utilization, including fixed and variable costs, contribution margin, and the key performance indicators (KPIs) that drive decision-making: utilization, turnover time, first-case on-time starts, and cancellation rates. The chapter also delineates the governance models that enable multidisciplinary alignment, highlighting the role of the anesthesiologist as Medical Director of Perioperative Services. Readers are introduced to data-driven scheduling models, predictive analytics, Lean and Six Sigma methodologies, and real-time dashboards as tools to enhance throughput and resource allocation. Special emphasis is placed on preoperative assessment, huddles, and team-based interventions that improve readiness and reduce inefficiency. Finally, the chapter addresses management of emergency and after-hours cases and the anesthesiologist’s evolving role as a systems-level change agent. Together, these strategies form a roadmap for perioperative leadership that integrates clinical insight, operational excellence, and economic value.