Staff Backend Software Engineer (Elixir) - Community

Papa•San Francisco, CA

About The Position

Papa is a new kind of care built on human connection. Across the country, health plans and employers look to Papa to provide vital social support by pairing older adults and families with Papa Pals, trained and vetted companions, who provide a helping hand and an open ear, resulting in less loneliness and better health. Founded in 2017 and headquartered in Miami, Papa is backed by Canaan, Tiger Global Management, Comcast Ventures, SoftBank Vision Fund 2, TCG, Initialized Capital, and Seven Seven Six, among other revered institutional and individual investors. We envision a world where no one has to go it alone. Learn more at Papa.com . You'll be joining Papa Community , a 0-to-1 venture within Papa that's building virtual care for seniors. You'll have the autonomy and velocity of an early-stage startup with the advantages of a growth-stage company including Papa's deep expertise serving older adults, established health plan relationships, and reliable capital. As one of the first engineers on Community, you'll have a significant tangible impact—from architecting our platform to establishing engineering culture. Every line of code you write will have a direct, measurable outcome for the business to improve patient outcomes and drive growth. About the role We are looking for our founding Staff Elixir Backend Software Engineer to build Community's technical foundation from the ground up. You'll be employee #1 on Papa Community’s engineering team, reporting directly to Papa Community's GM with dotted-line mentorship from Papa core’s engineering leadership. This role is unique because: You'll own the entire technical architecture for Papa Community. Unlike joining an established engineering org where you'd work on a narrow slice of the codebase, you'll make foundational decisions about system design, technology choices, and engineering practices that will define Community for years to come. You'll partner directly with the GM as a technical co-founder would. Your voice will shape product strategy, build vs. buy decisions, and business priorities. You won't just implement requirements—you'll help define what we build and why. You'll leverage Papa's infrastructure while maintaining startup velocity. You can access Papa's deployment pipelines, security compliance, and DevOps support - but make decisions in days, not weeks. You'll get institutional advantages without enterprise bureaucracy. Papa’s core business has had tremendous impact, and we are looking to bring even more results for patients with Papa Community: “Papa is the lynchpin that keeps me going month to month. They’re the piece of the team that allows the other pieces to happen…I can worry about finding another doctor if I have to. Finding another Papa doesn’t happen.” - Member from Tampa FL “Papa has kind of saved me. Now I have somebody to help me go to my appointments. I’ve got somebody to help me clean my house. I’ve got somebody to talk to. It just took so much pressure off my shoulders. I’m finally feeling like myself again.” - Member from Tacoma WA ”I look forward to seeing them. They make me laugh. I make them laugh. They’ve certainly taken lonely days from me also. It works both ways for us.” - Pal from Rhode Island What makes this role challenging: You'll navigate complex healthcare integrations. Our platform connects EHRs, care management platforms, revenue cycle management, and patient communication tools. You'll need deep expertise in healthcare data standards (FHIR, HL7, X12) and resilient API integration patterns. You'll balance technical perfection with shipping velocity. We're a startup - sometimes the right answer is "ship it and iterate" rather than "architect the perfect solution." You'll need judgment to know when to build for scale and when to move fast. You'll work in a high-autonomy environment, educate stakeholders, make recommendations, and own outcomes. If you need clear requirements and detailed tickets, this isn't the role for you.

Requirements

Product mindset - You think like a founder, balancing technical excellence with business outcomes, revenue, and patient impact. You see gaps as opportunities and help define what we build, not just how.
Strategic technical leadership - You lead large, complex projects with clear business impact. You influence senior leaders on engineering strategy and make compelling recommendations on build vs. buy decisions, strategic technical investments, and any relevant engineering decisions.
Deep backend expertise - Expert-level proficiency in Elixir with deep knowledge of distributed systems, API design, and building scalable architectures that solve problems long-term.
System design and reliability - You build resilient, well-tested systems with proper monitoring, rollout practices, and production stability for healthcare-critical workloads.
High autonomy and ownership - You thrive in ambiguous environments, educate non-technical stakeholders, and own outcomes without needing detailed requirements or constant direction.
Startup adaptability - You're highly communicative across operational and clinical teams, move fast when needed, and understand when to ship quickly versus architect for scale.
Continuous improvement mindset - You proactively identify areas for improvement in systems and processes without being asked, and drive initiatives to address them.
10+ years of software development experience
Expert-level proficiency in Elixir
Experience building and shipping high quality work and achieving high reliability
Experience improving quality through thoughtful code reviews, appropriate testing, proper rollout, and monitoring
Passionate about improving healthcare access and outcomes
Must be US-based with openness to travel for in-person collaboration

Nice To Haves

Experience with healthcare technology including data standards (FHIR, HL7, X12), EHR/vendor integrations, HIPAA-compliant systems for protected health information, and healthcare-specific APIs (clearinghouses, billing platforms)
Experience with Phoenix LiveView
Strong preference for candidates in the San Francisco Bay Area who can work in-person 2-3 days per week

Responsibilities

Build the technical foundation for virtual care delivery. You'll design and implement the core platform that connects our EHR, care management systems, billing infrastructure, and patient communication tools. This means creating robust integrations, establishing data flows, and ensuring HIPAA-compliant architecture that can scale as we grow to thousands of patients.
Enable operational intelligence and automation. You'll build the data infrastructure and tooling that allows our clinical team to make informed decisions, automate care workflows, and track patient outcomes in real-time. This includes everything from patient dashboards to automated patient outreach triggers to clinical decision support.
Lead critical technical decisions. You'll evaluate build vs. buy trade-offs, recommend technology choices, and architect solutions that balance immediate needs with long-term scalability. You'll partner with the GM and Papa's engineering leadership to shape our technical roadmap and determine when to leverage vendor tools versus building custom solutions.
Establish engineering practices. As the first engineer, you'll define code standards, testing expectations, deployment processes, and technical documentation practices, leveraging best practices from the Papa core engineering team.
Own system reliability and performance. You'll be responsible for production stability, monitoring, and continuous improvement of our platform. This means building resilient systems for healthcare-critical workflows where reliability isn't optional - claim submissions, patient data accuracy, and care coordination all need to work consistently.