Founding Engineer | AI-Native Ops Infrastructure
About The Position
Legion Health (YC S21) is building the AI-native operations layer for psychiatric care. We run our own psychiatric practice and are rebuilding what happens outside the visit—scheduling, intake, documentation, billing, risk detection, and coordination. Not “doctor-in-a-box,” but the operational backend that mental health actually runs on. Our agent infrastructure already supports 2,000+ patients with one human support lead. The systems you build will land in real clinical workflows immediately. Role: Founding Engineer – AI-Native Ops Infrastructure (In-Person SF) Hey—I’m Daniel, co-founder & CTO. I’m hiring a Founding Engineer to own core backend + agent systems end-to-end. You’ll help design and build the infrastructure that coordinates human clinicians, support staff, and AI agents like a single, coherent system. Roles evolve quickly here—including mine. I’m looking for someone who wants to grow into owning major parts of the system, not someone depending on me to stay in a narrow CTO role forever.
Requirements
- You’ve owned real systems 0→1 or 1→N, not just tickets.
- You think in events, state, and invariants, not just CRUD endpoints.
- You’re either already LLM-fluent or a strong systems/backend engineer who can get dangerous fast.
- You care about velocity and correctness—moving quickly while keeping things understandable and robust.
- You like small, high-candor teams and direct feedback.
- You want to see your work go live in production weekly, not sit on a roadmap.
Nice To Haves
- Experience with Node.js / TypeScript, Postgres, or Supabase.
- Experience with LLMs, agents, tool-calling, or RAG.
- Experience in healthcare, fintech, or other regulated / high-stakes domains.
- Experience in early-stage startups or founding teams.
Responsibilities
- Own our event-driven backend – Architect and scale our Node.js / TypeScript / Supabase (Postgres) / AWS stack. Design schemas, invariants, and workflows that encode how psychiatric care actually operates. Turn messy real-world processes into clean state machines and event streams.
- Build real LLM agents as coworkers – Implement tool use, retries, memory, and safety rails. Design action schemas and evaluation loops so agents can run reliably in production. Work on orchestration, context management, and multi-step workflows.
- Shape human + AI ops UX – Build internal tools used by both humans and agents. Make it trivial to see “what happened, why, and what should happen next” in any patient journey.
- Define world-state & simulation – Model the canonical state of a patient’s journey across time. Power alerting, routing, and decision-making from that live simulation.
- Own data, safety & compliance – Engineer HIPAA-compliant pipelines for transcripts, events, and EHR data. Ensure PHI access, agent actions, and human overrides are all auditable.
- Drive architecture & strategy – Work directly with me to debate tradeoffs, define new primitives, and decide what we build next.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
Number of Employees
11-50 employees
