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Agent guide: [/agents.md](https://www.wearedevelopers.com/agents.md). --- # 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, Interoperability, Python (Programming Language), PostgreSQL, Machine Learning, MySQL, Queueing Systems, Redis, Software Safety, Software Engineering, Systems Integration, Data Logging, Fast Healthcare Interoperability Resources, Flask (Web Framework), Caching, Electronic Medical Records, Backend, Agentic-AI, Fastapi, Event Driven Architecture, Deployment Automation, Health Level Seven International, Machine Learning Operations, Virtual Agents, Api Design, Restful APIs, Model Inference, Docker, Web Api, Microservices - **Published:** October 17, 2026 - **Apply:** https://www.careerbuilder.com/job-details/senior-backend-engineer-sf-san-francisco-ca--f6ac93b6-78b3-489a-bb5b-9ad17d61c8ef ## About the Role 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., * 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 ## Description Senior Backend Engineer - AI HealthcareThe OpportunityOur 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 OwnBuild and scale backend services in Python and FastAPI supporting millions of healthcare requestsDesign APIs and distributed systems that connect the core platform, AI models, healthcare data, and external partnersBuild integrations with EHRs, QHINs, telehealth platforms, healthcare networks, and third-party APIsArchitect secure systems for processing sensitive healthcare data in HIPAA-compliant environmentsOptimize PostgreSQL, Redis, caching, and data infrastructure for rapidly increasing trafficBuild reliable systems with strong error handling, failover, monitoring, and disaster recoveryDevelop backend infrastructure supporting AI inference, preprocessing, validation, and clinical workflowsBuild deterministic safeguards and escalation systems that operate alongside AI agentsImprove deployment infrastructure, observability, CI/CD, and multi-region reliabilityThe Engineering EnvironmentThis 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 organizationDirect access to company leadershipHigh individual ownership and autonomyMinimal specifications and significant freedom around implementationModern AI-assisted development toolsFast iteration and a bias toward shippingSenior engineers who own systems end-to-endThe 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 ForBackend Engineering6+ years of software engineering experience with significant backend ownershipStrong Python experienceExperience with FastAPI, Flask, Django, or similar frameworksDeep understanding of REST APIs and API architectureExperience designing systems handling significant production trafficStrong relational database experience with PostgreSQL or MySQLExperience with Redis, caching strategies, and distributed systemsCloud infrastructure experience, ideally in AWSSystems & InfrastructureYou should be comfortable working with:Microservices and distributed architecturesThird-party APIs and webhook integrationsDocker and containerized infrastructureCI/CD and deployment automationMonitoring, logging, and observabilityProduction reliability and failure recoverySecurity best practices for sensitive dataParticularly Relevant BackgroundsWe'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 technologyFintech or other regulated industriesHigh-scale SaaS platformsAI/ML infrastructureReal-time or event-driven systemsDeveloper infrastructure or API platformsExperience 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 HereThis environment is best suited for someone who:Wants significant ownership rather than narrowly scoped ticketsCan take an ambiguous problem and turn it into a production systemThinks deeply about reliability without allowing perfectionism to slow shippingEnjoys solving backend and infrastructure problems at scaleIs comfortable making technical decisions independentlyMoves quickly and exercises good judgmentWants their work to directly influence the trajectory of a companyFunding & MomentumThe company has attracted significant backing from leading technology investors:Seed: Union Square Ventures - February 2025Series A: Lightspeed Venture Partners - August 2025Series B: Abstract - January 2026Each 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 RoleThis 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 equityReporting: Direct access to company leadershipBenefits: Benefits reimbursement