The posting
About us
Our client is an AI-driven platform that makes healthcare more accessible by connecting patients to the right providers, offering transparent pricing, and simplifying medication management.
About the role
We're looking for a senior backend engineer to join a high-growth health tech company, where a small, elite team powers a large-scale platform serving hundreds of thousands of patients. You'll own core systems end-to-end — from clinical approval workflows and multi-pharmacy fulfillment routing to subscription billing and partner integrations — designing the schema, writing business logic, deploying to Kubernetes, and owning observability in production. If you're drawn to deep domain complexity, real autonomy, and work that directly shapes patient outcomes across an expanding range of care offerings, this is the role.
What You'll Do
Build and evolve subscription and billing infrastructure that handles the real complexity of healthcare commerce — mid-cycle medication changes, dynamic pricing across pharmacy partners, payment recovery, and prorated billing.
Own the systems powering medication ordering and fulfillment: reliable pipelines that handle compounding pharmacy integrations, controlled substance compliance, and personalized dosing protocols across a distributed network of external partners.
Take hands-on ownership of AWS and Kubernetes infrastructure — establishing CI/CD pipelines, building observability, and creating deployment patterns that let the entire team ship quickly and safely.
Work directly with Clinical, Operations, and Product teams to shape what gets built. Evaluate proposed workflows, take ownership of business outcomes, and find the most efficient paths to patient value.
Design backend architecture that enables AI-assisted agents to automate clinical operations, improve patient safety, and scale provider workflows — while also using agentic tools to accelerate your own development.
Raise the engineering bar through key architectural decisions, systematic modernization of legacy systems, rigorous code review, and mentorship of the engineers around you.
Who You Are
You bring 5–7+ years of backend engineering experience operating production systems with real complexity — not just high traffic, but distributed stateful workflows, complex domain logic, and deep third-party integrations.
You get data modeling right. You think carefully about schema design, state transitions, and domain boundaries, because you've seen what goes wrong downstream when the foundation is off.
You're an infrastructure owner — comfortable with, or eager to master, Kubernetes, Terraform, AWS, and CI/CD. Deploying your own code and owning its reliability in production is a core part of how you work.
AI has meaningfully changed how you work. You actively use frontier agentic tools to build faster, and you can speak concretely about how they've shifted your workflow — while maintaining the technical rigor to audit and own everything they produce.
You're low-ego, high-standards, and communicate well across functions. You're comfortable working where engineering decisions are shaped by compliance, regulation, and patient safety.
You're excited to work in-person five days a week in San Francisco.
For Staff-level candidates: You have a track record of setting technical direction, operating in ambiguity, and measurably growing the engineers around you.
Stack: TypeScript, Node.js, Express, PostgreSQL, Redis, Kubernetes, Terraform, AWS. Familiarity is a plus, but fundamentals, distributed systems experience, and domain reasoning come first.
