Senior Fullstack Engineer - Growth + Onboarding

Pivotal Health•New York, NY

5d•$180,000 - $210,000

About The Position

Pivotal Health is the leading technology platform that helps healthcare providers get paid fairly in an increasingly complex reimbursement landscape. Today, many providers face persistent underpayment from health insurance companies, despite delivering high-quality care. While processes like IDR (Independent Dispute Resolution) were designed to promote fairness, they’re often administrative-heavy, time-consuming, and difficult to navigate without the right tools. Pivotal Health combines software, data, and service into a seamlessly integrated, AI-driven platform that simplifies these complex reimbursement workflows. We help providers efficiently dispute underpaid claims, reduce administrative burden, and recover the reimbursement they’re entitled to; without adding more work to already stretched teams. Our full-service IDR solution is just the starting point. We’re building solutions that enable providers to operate with clarity, control, and confidence across the reimbursement journey. We're hiring a hands-on Engineering Manager to lead Pivotal's Integrations team, a backend-focused group building the infrastructure that connects our platform to the external systems our clients and providers depend on, including healthcare data sources, EHR platforms, billing systems, and partner APIs. This team is new and still taking shape, which means the right EM isn't just leading a function, they're helping define it. You'll be involved in customer and partner conversations, shaping how the team approaches integration problems at a technical and product level, and building a team that can work fluidly across messy real-world data, evolving requirements, and close customer collaboration. This is a true player-coach role. You will write code, drive delivery, and raise the bar for engineering quality today while also developing the team and establishing strong practices as we scale. If you're energized by greenfield scope, external-facing work, and the challenge of building something new, this role is for you.

Requirements

Bachelor's degree in STEM preferred; additional experience in lieu of a degree is also accepted
6+ years of professional software engineering experience, including recent hands-on backend work
2+ years of experience managing and developing engineers
Experience building or owning integrations with third-party APIs, healthcare systems, and data-heavy enterprise software
Strong customer-facing communication skills: you're comfortable in external conversations with customers and partners, not just internal stakeholders
Able to ask the right technical and business questions in discovery conversations and translate what you learn into engineering direction
Comfortable shaping team scope, contributing to hiring, and helping define a function that is still emerging
Experience working in product-driven environments with close product partnership
Strong technical judgment with a bias toward pragmatic, shippable solutions
Able to balance near-term delivery with longer-term technical health
Clear communicator who builds trust across engineering, product, and external partners
Thrives in early-stage or scaling environments where structure is evolving

Nice To Haves

Experience in healthcare integrations: EDI workflows (835/837), HL7/FHIR, ICD-10/CPT codes, or platforms like Epic or Cerner
Background in integration-heavy or forward-deployed engineering roles where customer proximity was part of the job
Experience with SFTP-based ingestion, data sharing pipelines, or clinical data access systems
Familiarity with Python in production backend environments
Experience at a Series A or early-stage startup where priorities evolve quickly and leaders wear multiple hats
Background in FinTech, healthcare, or another highly regulated industry
Familiarity with Python a plus

Responsibilities

Stand up and shape a new team: Help define how the Integrations function operates (hiring, scope, rituals, and engineering culture) while the team is still being built and ownership boundaries are still being established.
Lead as a player-coach: Contribute code, perform design reviews and PRs, and guide technical strategy while supporting the growth and effectiveness of the team.
Own the Integrations surface: Take end-to-end engineering ownership of the systems that connect Pivotal's platform to customers, external data sources, healthcare platforms,, and any partner APIs. Ensure integrations are reliable, scalable, and maintainable as the catalog grows.
Join customer and partner conversations: Be the technical voice in discovery and scoping conversations with customers and external partners. Ask the right questions, understand integration requirements deeply, and bring that context back into engineering execution.
Partner deeply with product: Collaborate closely with product to gather requirements, clarify scope, and translate integration needs into executable technical plans. Help shape solutions early rather than reacting late.
Drive execution and delivery: Own the engineering side of delivery (sprint planning, standups, retros, prioritization) ensuring the team ships consistently and learns from each cycle.
Translate ambiguity into clarity: Take loosely defined problems and help the team break them down into clear, achievable work with well-understood tradeoffs and success criteria.
Build lightweight process and rituals: Establish and evolve team workflows that improve focus and predictability without unnecessary ceremony.
Support and grow engineers: Coach engineers on execution, communication, and ownership across both IC and managerial tracks.