Senior Backend Engineer (SF)

NxT Level•San Francisco, CA

About The Position

Our client is building an AI-powered healthcare platform with an ambitious mission: make high-quality healthcare more accessible to everyone. The platform is already processing millions of healthcare interactions, and the next challenge is scale. They’re looking for a Senior Backend Engineer to build the infrastructure that can eventually support hundreds of millions — and potentially billions — of AI-driven consultations while maintaining the reliability, security, and clinical safeguards required in healthcare. This is a high-ownership engineering role for someone who enjoys building distributed backend systems, solving difficult infrastructure problems, and working in an environment where engineers are expected to own problems from idea through production.

Requirements

6+ years of software engineering experience with significant backend ownership
Strong Python experience
Experience with FastAPI, Flask, Django , or similar frameworks
Deep understanding of REST APIs and API architecture
Experience designing systems handling significant production traffic
Strong relational database experience with PostgreSQL or MySQL
Experience with Redis, caching strategies, and distributed systems
Cloud infrastructure experience, ideally in AWS
Comfortable working with Microservices and distributed architectures
Comfortable working with Third-party APIs and webhook integrations
Comfortable working with Docker and containerized infrastructure
Comfortable working with CI/CD and deployment automation
Comfortable working with Monitoring, logging, and observability
Comfortable working with Production reliability and failure recovery
Comfortable working with Security best practices for sensitive data

Nice To Haves

Experience with FHIR, HL7, EHR integrations, QHINs, HIPAA compliance, message queues, model serving, or AI agent infrastructure is valuable but not required.
Startup experience is highly relevant.
Founders, founding engineers, and engineers who have built systems during Seed through Series B growth tend to align well with the level of ownership expected here.

Responsibilities

Build and scale backend services in Python and FastAPI supporting millions of healthcare requests
Design APIs and distributed systems that connect the core platform, AI models, healthcare data, and external partners
Build integrations with EHRs, QHINs, telehealth platforms, healthcare networks, and third-party APIs
Architect secure systems for processing sensitive healthcare data in HIPAA-compliant environments
Optimize PostgreSQL, Redis, caching, and data infrastructure for rapidly increasing traffic
Build reliable systems with strong error handling, failover, monitoring, and disaster recovery
Develop backend infrastructure supporting AI inference, preprocessing, validation, and clinical workflows
Build deterministic safeguards and escalation systems that operate alongside AI agents
Improve deployment infrastructure, observability, CI/CD, and multi-region reliability