Staff Backend Engineer

We're hiring a Staff Backend Engineer to lead the evolution of the backend systems at the core of our product. A central focus of this role is transitioning our current AI and speech-to-text (STT) pipeline to an event-driven architecture - designing the events, messaging, and streaming patterns that let us process clinical audio and AI workloads reliably at scale. You'll work in a fast, hands-on environment, partnering closely with founders and the engineering team to solve real clinical workflow problems in production., * Lead the transition of our AI and STT pipeline to an event-driven architecture: design the events, queues, and streaming flows and drive the migration end to end.

• Partner with founders on backend strategy, architectural direction, and the technical roadmap.
• Architect reliable, secure, scalable backend systems that handle clinical audio, AI workloads, and sensitive data in production.
• Define messaging, queueing, and orchestration patterns (pub/sub, event streaming) and the standards for how services communicate.
• Build observability, monitoring, and feedback loops to catch reliability issues and regressions before customers do.
• Make pragmatic choices on frameworks, infrastructure, and tooling; balance reliability, cost, latency, and developer velocity.
• Contribute across the stack as needed to ship features end to end (we're early; everyone wears multiple hats).
• Establish backend engineering standards and help hire and mentor the team.
• Ship quickly with customers; measure impact and refine.
• Hold a high quality bar while executing autonomously.

Our tech stack

• Turborepo (monorepo)
• Frontend

• Core app: Expo/React Native (Web, Android, iOS)
• Admin portal: Next.js

• Backend: NestJS
• Database: PostgreSQL
• Infrastructure: GCP
• AI: LangChain leveraging Anthropic, OpenAI, and Gemini models

Do you have experience in TypeScript?, Must Haves

• Strong TypeScript expertise
• Deep experience designing and operating cloud native backend systems and distributed, event-driven architectures in production
• 7+ years of full-time engineering experience, including senior or staff-level technical leadership

Preferred

• Deep familiarity with our core backend stack: NestJS, PostgreSQL, and GCP (Next.js and React Native/Expo a plus)
• Hands-on experience with event-driven systems: message queues, pub/sub, and event streaming (e.g., Pub/Sub, Kafka, or similar)
• Experience with real-time or streaming data pipelines, audio/STT, or AI/LLM workloads in production
• DevOps and CI/CD proficiency - containers and cloud deployments (GCP a plus)
• Proven builder who's taken backend systems from concept to production at scale
• Startup mindset: high ownership, autonomous, and a strong bias to action (prior startup experience preferred)
• Bay Area-based and able to work in-person 3 days/week
• Interest in healthcare and clinical workflows; mission-driven a plus

Pulled from the full job description

• Vision insurance
• Dental insurance, * Open to Feedback - Questions and code suggestions are about the product, not the person. We assume positive intent and don't let frustration leak into how we treat each other.
• Constructive Disagreement - Speak up if you see a better path. We weigh trade-offs together and pick the right solution for our current priorities.
• Shared Ownership - We collectively own the codebase. Individuals may focus on certain areas, but nothing is siloed - anyone should be able to jump in.
• Autonomy with Judgment - Not everything will be perfectly defined. Take initiative and move things forward, and know when to pull others in.
• Ownership of Output (AI Included) - Whether you wrote it or an AI did, your commits are your responsibility. Review it, refine it, stand behind it. We ship intentional work, not blindly generated output., * Competitive salary and meaningful equity.
• Health, dental, and vision insurance.
• Unlimited time off, with a minimum of 3 weeks per year encouraged.
• Immigration sponsorship, as long as your situation allows you to start within roughly the next month.

Our founders

Our founders have prior successful exits in health tech and augmented reality, including an acquisition by $76B NASDAQ-100 component Cadence Design Systems. They have advised on over $78B in healthcare and life sciences M&A and hold master's degrees in healthcare management and biotechnology from Johns Hopkins University. Their experience spans Intermountain Health ($12B health system), Neuralink, Meta, Becton Dickinson, Under Armour, Deloitte, KPMG, Cadence, and 500 Startups, with a shared passion for bringing new technologies to market that help people around the world.

Clinicians spend more time clicking through outdated software than caring for patients-often 4,000+ clicks per shift. We're building modern tools that give that time back to patient care.