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# Senior Backend Engineer (SF)

- **Company:** NxT Level
- **Location:** San Francisco, CA, United States
- **Experience:** Expert
- **Salary:** $200,000.0 - $240,000.0
- **Contract:** Permanent contract
- **Skills:** Application Programming Interfaces (APIs), Artificial Intelligence, Amazon Web Services, Software as a Service, Cloud Computing, Continuous Integration, Data Infrastructure, Data Transformation, Data Security, Relational Databases, Programming Tools, Disaster Recovery, Distributed Systems, Django Web Framework, Failover, Python (Programming Language), PostgreSQL, MySQL, Queueing Systems, Redis, Software Engineering, Systems Integration, Data Logging, Fast Healthcare Interoperability Resources, Flask (Web Framework), Caching, Electronic Medical Records, Backend, Fastapi, Event Driven Architecture, Deployment Automation, Health Level Seven International, Machine Learning Operations, Virtual Agents, Api Design, Restful APIs, Docker, Web Api, Microservices
- **Published:** August 22, 2026
- **Apply:** https://www.wayup.com/i-j-Senior-Backend-Engineer-SF-NxT-Level-867558450039577/

## About the Role

Our client is building an AI-powered healthcare platform with an ambitious mission: make high-quality healthcare more accessible to everyone., + 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.

## Description

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.


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