Senior Backend Engineer
$230,000–$280,000 year
On-siteSan Francisco, California, United States
Job Summary
Architect healthcare commerce systems handling subscription billing, dynamic pricing, and payment recovery for a multi-pharmacy marketplace. Build clinical state machines managing medication ordering, compounding pharmacy integrations, and personalized dosing protocols across external partners. Own end-to-end infrastructure including AWS, Kubernetes, CI/CD pipelines, and production observability. Act as a product partner with Clinical, Operations, and Product teams to shape workflows and drive business outcomes. Design backend architecture enabling AI-assisted agents to automate clinical operations and scale provider workflows. This Senior Backend Engineer role targets candidates with 5-7+ years of experience in high-stakes distributed systems and complex domain logic. Interviews include remote technical rounds, behavioral discussions, and an on-site team meeting in San Francisco.
Required Qualifications
- 5-7+ years of backend engineering experience
- Experience building and operating production systems that handle complex domain logic, distributed stateful workflows, and deep integrations with external partners
- Comfort with (or eagerness to master) Kubernetes, Terraform, AWS, and CI/CD
- View of deploying own code and owning system reliability as a fundamental part of backend engineering
- Experience with TypeScript
- Experience with Node.js
- Experience with Express
- Experience with PostgreSQL
- Experience with Redis
- Experience with Kubernetes
- Experience with Terraform
- Experience with AWS
- Experience with distributed systems
- Experience with domain reasoning
- Ability to describe specific ways frontier agentic tools have structurally changed how they code
- Ability to audit, verify, and own the output of AI-generated code
- Low ego and high standards
- Excellent communication skills
- Ability to thrive in cross-functional environments where engineering requirements are heavily shaped by healthcare regulations, compliance, and patient safety
- Excitement to work in-person
- Willingness to build alongside the team 5 days a week in the San Francisco office
- Demonstrated track record of setting technical direction across teams (for Staff leveling)
- Ability to navigate deep ambiguity
- Ability to measurably level up engineers around them (for Staff leveling)
Desired Qualifications
- Experience with healthcare commerce, subscription and billing infrastructure
- Experience with complex medication ordering and fulfillment systems
- Experience with compounding pharmacy integrations
- Experience with controlled substance compliance
- Experience with personalized dosing protocols
- Experience with AI-assisted agents automating clinical operations
- Experience with provider workflows
- Experience with high-stakes systems
- Experience with schema design, state transitions, and domain boundaries
- Experience with clinical approval workflows
- Experience with multi-pharmacy fulfillment routing
- Experience with payment recovery
- Experience with prorated billing
- Experience with dynamic pricing across different pharmacy partners
- Experience with backend architecture that allows AI-assisted agents to automate clinical operations
- Experience with frontier agentic models (e.g., Codex 5.3, Claude Opus 4.6)
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