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# Founding Backend Engineer

- **Company:** NxT Level
- **Location:** New York, NY, United States
- **Experience:** Expert
- **Contract:** Permanent contract
- **Skills:** Application Programming Interfaces (APIs), Artificial Intelligence, Data Analysis, Application Integration Architecture, Information Engineering, Data Infrastructure, Extract Transform Load (ETL), Systems Integration, Fast Healthcare Interoperability Resources, Large Language Models, Electronic Medical Records, Backend, Data Layers, Event Driven Architecture
- **Published:** October 22, 2026
- **Apply:** https://www.thejobnetwork.com/job/9c1ff3cc-53a2-4af2-bf4f-beb42eab56d8/founding-backend-engineer

## About the Role

* Experience with healthcare workflows, EMRs/EHRs, home health, or revenue-cycle concepts (authorization, billing, reimbursement)
 * Familiarity with healthcare data modeling standards (e.g., FHIR-style entity thinking)
 * Experience building experimentation frameworks or measurement systems tied to business outcomes
 * Background in data platform teams (data engineering + backend/platform) at high-growth startups

## Description

Our client is hiring a Founding Senior Backend Engineer to own the data platform end-to-end and build the team around it. This is a true founding role: you will define canonical data models, ship the event backbone, enable analytics/experimentation, and create the integration architecture that makes adding EMR #5 configuration-not months of bespoke engineering.

If you're energized by unglamorous but high-leverage infrastructure (data modeling, pipelines, events, integrations), this is a rare seat.

What You'll Own

1) Outcome Data Layer (Instrumentation + Measurement)

Build the instrumentation layer that ties every agent decision to customer-level business metrics-e.g., client retention, caregiver satisfaction, authorization utilization, hours erosion. This becomes the foundation for experimentation, ROI claims, ML improvements, and product strategy.

2) Real-Time Event Backbone

Design an event-driven architecture where visit status changes, clock-ins, call-outs, ranking decisions, and workflow outcomes flow in real time-so internal systems (and future products) can consume events without constant EMR polling or rate-limit band-aids.

3) Integration Platform + Canonical Models

Create canonical data models across WellSky, HHAeXchange, AlayaCare, and Axxess so adding the next EMR is configuration-driven. This also unlocks revenue-cycle automation by enabling unified authorization and billing models.

4) Analytics & Experimentation Tooling

Build the warehouse + tooling so engineers can answer: "Did this change improve customer outcomes?" quickly and consistently-without writing one-off queries every time.

What Our Client Is Looking For

You're likely a fit if you are:

 * Systems-minded and data-opinionated: you treat data modeling as a craft and can explain why entities should relate a certain way
 * Comfortable with messy reality: you're excited by pipelines, joins, ETL/ELT, and cleaning inconsistent third-party data
 * Event-driven by default: you've built (or deeply understand) real-time architectures, streaming/event backbones, and durable systems
 * Integration-savvy: you've shipped platforms that unify multiple external systems into clean internal abstractions
 * AI-native and curious: you naturally look for leverage (LLMs for parsing/structuring, automation for data QA, agent-based extraction when APIs don't exist), Q2: Ship the outcome data layer + real-time event backbone. Make experimentation and measurable ROI a default.
Q3: Deliver the integration abstraction + canonical models. EMR #5 becomes configuration. RCM roadmap becomes real.
Year-end: You've built and are leading a 3-5 person data platform team (integration, data engineering, analytics). You're operating as the Head of Data Platform.

Why This Role

 * Founding-level ownership on a platform that directly drives revenue outcomes
 * Complex, high-impact systems work: data, events, integrations, measurement, experimentation
 * Clear path to technical leadership and building a team
 * Real customers, real workflows, and real-world leverage-your architecture decisions compound fast