Founding Backend Engineer - AI Agents

Nestmed • San Francisco, CA

10d • Onsite

About The Position

Healthcare documentation is broken. Nestmed is fixing it with an AI platform that gives clinicians their time back. In just one year, we’ve scaled to support tens of thousands of clinicians across more than a million patient visits. We're now the trusted partner for over 60 home health agencies, including 7 of the top 10 enterprises in the US. Our founding team—hailing from Stanford, YC, Google, and Meta—is backed by the founders of PayPal and Plaid to build the essential infrastructure for the future of the $500B home healthcare industry. About the Role Clinicians spend 80% of their time on manual administrative work that could be automated. As the founding Backend Engineer on our AI Agents team, you'll build AI agents for better patient care and to support providers by eliminating this administrative burden, allowing healthcare providers to focus entirely on patient care. You'll develop AI agents that handle everything from complex scheduling coordination with hospitals and primary care doctors to quality assurance reviews and medical coding. These aren't simple chatbots—they're sophisticated multi-step workflows that understand healthcare context, integrate with multiple systems, and make autonomous decisions that directly impact patient outcomes. Beyond administrative automation, you'll build clinician support agents that identify at-risk patients, proactively follow up with families, and provide real-time insights that help providers deliver 10x better care. This is AI engineering at its most impactful: your code will directly improve healthcare delivery for thousands of patients. You'll start as the founding engineer building autonomous healthcare agents and grow this into a specialized team of AI engineers focused on clinical workflow automation.

Requirements

• 5+ years of backend engineering experience with focus on workflow automation, state machines, or distributed systems
• Strong AI/ML engineering background with production experience deploying and orchestrating LLMs, including prompt engineering and model fine-tuning
• Experience building workflow orchestration systems using frameworks like Temporal, Airflow, or custom state machine implementations
• Understanding of healthcare workflows or other complex, regulated industries with multi-stakeholder coordination and compliance requirements
• Proficiency in Python and experience with AI frameworks, vector databases, and building reliable AI systems that handle edge cases gracefully
• Track record building autonomous systems that make decisions with minimal human intervention while providing clear audit trails and intervention points
• Experience with API integrations and building systems that coordinate between multiple external services with different reliability characteristics
• San Francisco-based and excited about working closely with clinical teams to understand real-world healthcare workflows

Responsibilities

• Design and build autonomous AI agents that execute complex healthcare workflows end-to-end, from patient scheduling to clinical documentation and quality assurance
• Develop multi-step workflow orchestration systems that coordinate between LLMs, external APIs, and business logic to handle tasks like insurance authorization and care coordination
• Build state machines and workflow engines that can handle complex branching logic, error recovery, and human-in-the-loop interventions for clinical decision-making
• Implement intelligent patient monitoring systems that analyze clinical data streams to identify risks and automatically trigger appropriate care interventions
• Create robust integration layers with EMRs, scheduling systems, communication platforms, and insurance APIs using HL7 FHIR and EDI standards
• Design agent orchestration frameworks that can spawn, monitor, and coordinate hundreds of concurrent AI agents processing different patient cases
• Build comprehensive observability and control systems that provide clinicians visibility into agent decisions and the ability to override when necessary
• Collaborate with clinical teams to understand complex care workflows and translate them into reliable automated processes

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed