Senior Backend Engineer — AI Healthcare
The Opportunity
Our client is building an AI-powered healthcare platform with an ambitious mission: make high-quality healthcare more accessible to everyone.
The platform is already processing millions of healthcare interactions, and the next challenge is scale. They’re looking for a Senior Backend Engineer to build the infrastructure that can eventually support hundreds of millions — and potentially billions — of AI-driven consultations while maintaining the reliability, security, and clinical safeguards required in healthcare.
This is a high-ownership engineering role for someone who enjoys building distributed backend systems, solving difficult infrastructure problems, and working in an environment where engineers are expected to own problems from idea through production.
What You'll Own
Build and scale backend services in Python and FastAPI supporting millions of healthcare requests
Design APIs and distributed systems that connect the core platform, AI models, healthcare data, and external partners
Build integrations with EHRs, QHINs, telehealth platforms, healthcare networks, and third-party APIs
Architect secure systems for processing sensitive healthcare data in HIPAA-compliant environments
Optimize PostgreSQL, Redis, caching, and data infrastructure for rapidly increasing traffic
Build reliable systems with strong error handling, failover, monitoring, and disaster recovery
Develop backend infrastructure supporting AI inference, preprocessing, validation, and clinical workflows
Build deterministic safeguards and escalation systems that operate alongside AI agents
Improve deployment infrastructure, observability, CI/CD, and multi-region reliability
The Engineering Environment
This is not a heavily layered engineering organization.
There are no project managers handing engineers perfectly defined tickets. Engineers are expected to understand the problem, make good technical decisions, and ship.
You'll work in an environment with:
A flat engineering organization
Direct access to company leadership
High individual ownership and autonomy
Minimal specifications and significant freedom around implementation
Modern AI-assisted development tools
Fast iteration and a bias toward shipping
Senior engineers who own systems end-to-end
The expectation isn't simply to write good code.
It's to identify what needs to be built, make the right tradeoffs, and get it into production.
What We're Looking For
Backend Engineering
6+ years of software engineering experience with significant backend ownership
Strong Python experience
Experience with FastAPI, Flask, Django, or similar frameworks
Deep understanding of REST APIs and API architecture
Experience designing systems handling significant production traffic
Strong relational database experience with PostgreSQL or MySQL
Experience with Redis, caching strategies, and distributed systems
Cloud infrastructure experience, ideally in AWS
Systems & Infrastructure
You should be comfortable working with:
Microservices and distributed architectures
Third-party APIs and webhook integrations
Docker and containerized infrastructure
CI/CD and deployment automation
Monitoring, logging, and observability
Production reliability and failure recovery
Security best practices for sensitive data
Particularly Relevant Backgrounds
We're especially interested in engineers who have worked on difficult technical problems in environments where reliability and data security matter.
Relevant experience could include:
Healthcare technology
Fintech or other regulated industries
High-scale SaaS platforms
AI/ML infrastructure
Real-time or event-driven systems
Developer infrastructure or API platforms
Experience with FHIR, HL7, EHR integrations, QHINs, HIPAA compliance, message queues, model serving, or AI agent infrastructure is valuable but not required.
Startup experience is highly relevant. Founders, founding engineers, and engineers who have built systems during Seed through Series B growth tend to align well with the level of ownership expected here.
Who Tends to Thrive Here
This environment is best suited for someone who:
Wants significant ownership rather than narrowly scoped tickets
Can take an ambiguous problem and turn it into a production system
Thinks deeply about reliability without allowing perfectionism to slow shipping
Enjoys solving backend and infrastructure problems at scale
Is comfortable making technical decisions independently
Moves quickly and exercises good judgment
Wants their work to directly influence the trajectory of a company
Funding & Momentum
The company has attracted significant backing from leading technology investors:
Seed: Union Square Ventures — February 2025
Series A: Lightspeed Venture Partners — August 2025
Series B: Abstract — January 2026
Each subsequent round was raised within months of the prior financing, giving the team significant resources to continue scaling the platform and engineering organization.
Why This Role
This is an opportunity to build foundational infrastructure at the intersection of AI, distributed systems, and healthcare.
You'll have the chance to solve technically challenging problems around scale, reliability, healthcare interoperability, AI safety, and sensitive data — while working on a product designed to materially expand access to healthcare.
Compensation: Competitive salary ($200,000 - $240,000) + meaningful equity
Reporting: Direct access to company leadership
Benefits: Benefits reimbursement