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Karl-Erik Nilsson was a teacher in the region of Kalmar’s schools before going into politics. He served as mayor of his home town, Emmaboda, from 1995 until 2006, when he left active politics. His first post in football administration was at local club Lindås BK. In the 1980s, Nilsson started out as a referee, and went on to officiate in the UEFA Champions League and at various FIFA and UEFA competitions.

Nilsson was elected Swedish Football Association (SvFF) president in March 2012. Before that, he was a member of the SvFF board, as well as president of the Bohuslan regional association, and also served on the board of IK Oddevold, a club in his new home town Uddevalla. He was tournament director at the 2009 UEFA European Under-21 Championship and had several other UEFA assignments, working as a referee observer and mentor for younger officials

In April 2017, Nilsson was elected to the UEFA Executive Committee at the Helsinki Congress, and became UEFA first vice-president.