Staff Backend Software Engineer (Elixir) - Community

You'll help own the technical architecture for Papa Community. Unlike joining an established engineering org where you'd work on a narrow slice of the codebase, you'll make foundational decisions about system design, technology choices, and engineering practices that will define Community for years to come.

You'll own problems, not tickets. You won't be handed a fully-scoped spec and asked to implement it - you'll be handed a problem the business is facing and given real latitude to figure out the best way to solve it. If what excites you is being trusted to figure out what to build and why, this is the role for you.

You'll partner directly with the GM, much as a technical co-founder would. Your voice will shape product strategy, build vs. buy decisions, and business priorities.

You'll leverage Papa's infrastructure while maintaining startup velocity. You can access Papa's deployment pipelines, security compliance, and DevOps support - but make decisions in days, not weeks, and ship at a pace that matches the urgency of the people we serve. You'll get institutional advantages without enterprise bureaucracy.

What makes this role challenging:

You'll navigate complex healthcare integrations. Our platform connects EHRs, care management platforms, revenue cycle management, and patient communication tools. You'll need deep expertise in healthcare data standards (FHIR, HL7, X12) and resilient API integration patterns.

You'll balance technical perfection with shipping velocity. We're a startup - sometimes the right answer is "ship it and iterate" rather than "architect the perfect solution." You'll need judgment to know when to build for scale and when to move fast, and a genuine bias for action.

You'll work in a high-autonomy environment with a lot of open questions and comparatively little established process. You'll influence stakeholders, make recommendations, and own outcomes.

What you'll do:

Build the technical foundation for virtual care delivery. You'll help design and implement the core platform that connects our EHR, care management systems, billing infrastructure, and patient communication tools. This means creating robust integrations, establishing data flows, and ensuring HIPAA-compliant architecture that can scale as we grow to thousands of patients.

Enable operational intelligence and automation. You'll build the data infrastructure and tooling that allows our clinical team to make informed decisions, automate care workflows, and track patient outcomes in real-time. This includes everything from patient dashboards to automated patient outreach triggers to clinical decision support.

Lead critical technical decisions. You'll evaluate build vs. buy trade-offs, recommend technology choices, and help architect solutions that balance immediate needs with long-term scalability. You'll partner with the GM to shape our technical roadmap.

Help establish engineering practices. You'll help define code standards, testing expectations, deployment processes, and technical documentation practices as we grow the team - building the muscle for future engineering hires, not just following what's already there.

Own system reliability and performance. You'll be responsible for production stability, monitoring, and continuous improvement of our platform. This means building resilient systems for healthcare-critical workflows where reliability isn't optional - claim submissions, patient data accuracy, and care coordination all need to work consistently.

A genuine appetite for ambiguity and ownership - You're energized by open questions and evolving standards. You don't wait to be handed a fully-scoped task - you enjoy taking ownership of the problem itself and figuring out the right way to solve it.

A bias toward velocity - You want to ship, see it working, and iterate. You feel the urgency of building something that patients and clinicians depend on.

Product mindset - You think like a founder, balancing technical excellence with business outcomes, revenue, and patient impact. You see gaps as opportunities and help define what we build, not just how.

Strategic technical leadership - You lead large, complex projects with clear business impact. You influence senior leaders on engineering strategy and make compelling recommendations on build vs. buy decisions and strategic technical investments.

Deep backend expertise - Expert-level proficiency in Ruby or Python, with deep knowledge of distributed systems, API design, and building scalable architectures. We build in Elixir, so hands-on Elixir experience matters - see qualifications below - but strong Ruby/Python fundamentals translate quickly.

System design and reliability - You build resilient, well-tested systems with proper monitoring, rollout practices, and production stability for healthcare-critical workloads.

High autonomy and ownership - You thrive in ambiguous environments, educate non-technical stakeholders, and own outcomes without needing detailed requirements or constant direction.

Startup adaptability - You're highly communicative across operational and clinical teams, move fast when needed, and understand when to ship quickly versus architect for scale.

Continuous improvement mindset - You proactively identify areas for improvement in systems and processes without being asked, and drive initiatives to address them., * 9+ years of software development experience

• Expert-level proficiency in Ruby or Python
• 2+ years of hands-on, professional experience with Elixir
• Experience building and shipping high quality work and achieving high reliability
• Experience improving quality through thoughtful code reviews, appropriate testing, proper rollout, and monitoring
• Passionate about improving healthcare access and outcomes, * Experience working as one of the first engineers at an early-stage startup, or otherwise building without an established engineering org around you
• Deeper Elixir expertise, including Phoenix LiveView
• Experience with healthcare technology including data standards (FHIR, HL7, X12), EHR/vendor integrations, HIPAA-compliant systems for protected health information, and healthcare-specific APIs (clearinghouses, billing platforms)

2.82.8 out of 5 stars San Francisco, CA Hybrid work $200,000 - $230,000 a year, Pulled from the full job description

• Parental leave
• Health insurance
• 401(k) matching
• Paid time off
• Vision insurance
• Health savings account
• Dental insurance, * Target Salary Range: $200,000 - $230,000 (Actual compensation determined by candidate experience, location, education, certifications, and skill set).
• Equity: Meaningful equity package.
• Health & Wellness: Medical, dental, and vision insurance coverage; Health Savings Account (HSA) & Flexible Spending Account (FSA).
• Retirement: 401(k) plan with a company matches up to 4%.
• Time Off: Flexible PTO, 11 paid company holidays, parental leave, and caregiver leave.

Papa is a new kind of care built on human connection. Across the country, health plans and employers look to Papa to provide vital social support by pairing older adults and families with Papa Pals, trained and vetted companions, who provide a helping hand and an open ear, resulting in less loneliness and better health. Founded in 2017 and headquartered in Miami, Papa is backed by Canaan, Tiger Global Management, Comcast Ventures, SoftBank Vision Fund 2, TCG, Initialized Capital, and Seven Seven Six, among other revered institutional and individual investors. We envision a world where no one has to go it alone. Learn more at Papa.com. You'll be joining Papa Community, a 0-to-1 venture within Papa based in San Francisco that's building virtual care for seniors. You'll have the autonomy and velocity of an early-stage startup with the advantages of a growth-stage company including Papa's deep expertise serving older adults, established health plan relationships, and reliable capital. As one of the early team members on Community, you'll have a significant tangible impact to improve patient outcomes and drive scalability. Founded in 2017, Papa is backed by Canaan, Tiger Global Management, Comcast Ventures, SoftBank Vision Fund 2, TCG, Initialized Capital, and Seven Seven Six, among other revered institutional and individual investors. We envision a world where no one has to go it alone. Learn more at Papa.com.About the Role: We are expanding our founding engineering team and looking for a Staff Backend Software Engineer to join Papa Community and help build our technical foundation. You'll be our second engineer, working alongside another Staff Engineer and reporting directly to Papa Community's GM, with dotted-line mentorship from Papa core's engineering leadership. This is a rare chance to shape a platform from its earliest days without giving up the stability of an established company behind you. As Papa Community's engineering team grows, there will be more opportunities to take on broader technical leadership - this role is a chance to build that track record early, working shoulder-to-shoulder with our senior team members.