Senior Backend Engineer

Full timeEngineeringSenior Backend EngineerOwn the layer that powers agent reasoning — figuring out what patient context to inject, when, and how to keep it coherent across a lifetime of care. You'll also build the Kafka pipelines that make every agent action auditable and immutable.Apply nowSenior Backend EngineerLocation: Grand Rapids, MI preferred / RemoteExperience: 7+ yearsCompensation: Competitive salary + meaningful equityWhy nowEHRs are 20 years old and optimized for billing, not care. AI agents just crossed from "demo" to "useful." Healthcare has a million unfilled positions. The window to build the Autonomous Health System is open now — and the architecture decisions we make this year will compound for a decadeThe problemWe're building an Agentic Staffing Agency for Medicine — Holmes, Kelly, and 30+ AI agents you can hire. Not features, not chatbots. Colleagues.What You'll Build FirstGraph layer for agent reasoning. We've built a probabilistic medical graph — the intelligence our agents reason over. The hard problem: a patient's full context far exceeds any agent's context window, and even if it didn't, packing it full wouldn't work. You'll figure out what context to inject, when, and how to maintain temporal coherence across a patient's entire journey.Graph DB selection, RAG architecture, query patterns — we have opinions, you should have better ones. This is yours to own.AI mistakes are funny in consumer apps. In healthcare, they're not. You'll make sure we can do this safely at scale.You'll also own event-driven architecture: Kafka pipelines that make agent workflows auditable and immutable. ReBAC permissions that don't care if the actor is a clinician or AI. Same model. Same audit trail.How We WorkWe've stopped writing code by hand. We specify, evaluate, and debug — implementation is delegated. When AI generates something wrong, we fix the spec that let it happen. Every iteration improves the system.Spec reviews before implementation. Plan reviews before code exists. Zero surprises in the PR.You're a fit if you haveDeep distributed systems experience — years of doing this, not reading about itShipped with AI-assisted workflows and can show how you actually work nowEvent-driven architecture depth — Kafka, not "or similar"Strong opinions about architecture decisions compounding when implementation is cheapAlso great if you haveHealthcare/HIPAA experienceGraph database or graph RAG experienceBeen a founder or early-stage engineerBeen paged at 2am and have opinions about whyWhy HealiomPre-Series A. 12 engineers. Real equity. Architectural influence from day one.‍Apply now