Senior Backend Engineer, Patient Experience

Mochi Health•San Francisco, CA

8d•$230,000 - $280,000•Onsite

About The Position

We’re looking for a Senior Backend Engineer to help build Mochi’s patient platform — the commerce, clinical, and fulfillment infrastructure that connects patients to medications across a growing number of care categories. Mochi has helped hundreds of thousands of patients lose over 5 million pounds. The backend systems you design will power how the next wave of patients discover medications, qualify for treatment, receive prescriptions, and manage ongoing care. As a senior member of the engineering team, you will own the design and development of backend systems that power core patient workflows — ordering, billing, prescribing, fulfillment, and subscription management. You will architect systems that support multiple medication types, pharmacy partners, and purchase models, and ensure our infrastructure keeps pace as we expand into new areas of care. Mochi is an AI-first engineering organization — we build with AI tooling, we ship AI-powered automation into our products, and we expect engineers to push both forward. Healthcare commerce is genuinely complex. A single patient order can involve clinical approval workflows, multi-pharmacy fulfillment routing, subscription billing, and regulatory constraints — and all of it needs to work reliably at scale. If you’re drawn to systems problems where the domain complexity is real and the impact is tangible, this is that role.

Requirements

5-7+ years of backend engineering experience. You’ve built and operated production systems that handle real complexity — not just traffic, but complex domain logic, stateful workflows, and integration with external partners
You get data modeling right. You think carefully about schema design, state transitions, and domain boundaries, because you’ve seen what happens downstream when the model is wrong
You build things that run in production, not just pass review. You care about observability, failure modes, and what happens at 2 AM when something breaks. You’ve debugged systems under pressure and improved them afterward
You ship end to end — from scoping and design through deployment and monitoring. You take ownership of outcomes, not just code
You’re already using AI tools to build faster and you’re excited about pushing that further — whether that’s agentic development workflows, AI-powered automation, or finding new ways to apply LLMs to real problems
Strong collaborator with excellent communication skills, able to work cross-functionally with clinical, product, and operations teams where the requirements are shaped by healthcare and regulatory constraints
Excited to work in-person with our team in San Francisco
Our stack is TypeScript, Node.js, Express, PostgreSQL, Redis, Kubernetes, and AWS. Experience with these is a plus, but we care more about engineering fundamentals than language-specific expertise

Nice To Haves

You’ve worked with payment infrastructure (Stripe preferred) — subscription billing, payment recovery, or the kind of billing complexity that shows up in healthcare
You’ve built software in healthcare, pharmacy, or other regulated environments where compliance isn’t optional and patient safety shapes the architecture
You’ve integrated with external partners at scale — fulfillment systems, marketplace APIs, or multi-vendor platforms where you don’t control the other side
You’ve migrated or evolved complex production systems without breaking them — you know what dual-writes, phased cutovers, and careful rollouts look like in practice
You’ve experimented with AI-powered development tools, agentic workflows, or LLM-based automation — and you have opinions about where they work and where they don’t.

Responsibilities

Own the backend systems that power medication ordering and fulfillment — from the moment a patient selects a medication through clinical approval, pharmacy routing, and delivery, across multiple pharmacy partners and fulfillment channels
Build and evolve subscription and billing infrastructure that supports multiple purchase models, payment recovery, and pricing that varies by pharmacy and medication type
Design the data models and domain architecture that underpin ordering, prescribing, and clinical workflows — ensuring they generalize cleanly as Mochi expands across care categories
Architect the systems that connect clinical workflows to the patient experience — health checks, prescribing approvals, and medication management that work across different treatment categories, with AI-assisted automation where it can improve speed, accuracy, and patient outcomes
Collaborate with Product, Clinical, and Operations teams to translate healthcare and regulatory requirements into backend systems that are reliable, auditable, and maintainable. Own key architectural decisions, mentor engineers, and raise the engineering bar through code review, testing practices, and technical standards — including how the team uses AI tooling to ship faster and with more confidence

Benefits

Daily Meals and Espresso Bar - Breakfast, lunch, and dinner every weekday. Our on-site barista keeps the espresso and matcha flowing all day
Pre-Tax Commuter Perks - Save on transit and parking through pre-tax commuter benefits
Top-of-Market Compensation - We offer competitive salaries along with generous equity packages so you can share in the success you help create
Profitable and Rapid Growth - We’re scaling fast, with financial discipline and long-term vision. No VC constraints, just sustainable momentum and smart decisions
High-Impact Work - Help shape the future of digital healthcare. Your work here directly improves lives and scales nationwide
World-Class Team - Collaborate with teammates from Tesla, SpaceX, Citadel, Harvard, IIT, and more. We value excellence, humility, and empathy in equal measure
Comprehensive Benefits - 401(k) with match, generous time off, life insurance, and high-quality medical, dental, and vision plans
Mochi Health Membership – We cover your monthly subscription fee so you can experience the same care as our patients (medications not included)
Time to Recharge – Enjoy unlimited PTO, generous company holidays, and true flexibility. We trust you to take the time you need to rest, reset, and thrive
Wellness First – From weekly mindfulness sessions to group workouts and fitness perks, your physical and mental health are top priority
Team Socials and Community - We make time to connect through regular socials, happy hours, and spontaneous events. Our stocked kitchen doesn’t hurt either
Downtown SF HQ - Our San Francisco office is just steps from BART, Muni, and great food. It’s designed for deep work and casual collaboration