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O'Brien was confirmed as Meath manager on 10 November 2008 after a meeting with the county board to succeed Colm Coyle. His team had a reasonably successful 2009 season, where they were defeated by Dublin in the Leinster quarter finals, but went through the qualifier system to reach the All-Ireland semi finals, where they were defeated by Kerry.
In 2010, O'Brien's team comprehensively defeated Dublin in the Leinster Semi finals, and went on to win the Leinster final in controversial circumstances against Louth. In this match, Meath forward Joe Sheridan was awarded a goal in the final minutes which on replay evidence should not have stood, to give Meath a 2 point win. Appeals for a replay were refused. Meath went on to be beaten by Kildare in the All-Ireland Quarter Finals.
On 6 September 2010 O'Brien was unexpectedly axed as manager after many of the county's clubs voted him out.
On November 10, 2010 Former Monaghan manager Seamus McEnaney was confirmed as the new Meath manager.