Location: New York City (Hybrid, 3 days in office per week)

About the Role

We're hiring a senior backend engineer to build and own core backend systems and application logic.

You'll design and build the services that power reliable clinical and operational workflows, including APIs, background processing, and system behavior under real-world conditions. This role focuses on reliability, correctness, and predictable execution as the product grows.

You do not need prior healthcare or FHIR experience. We care more about strong backend fundamentals, sound engineering judgment, and the ability to ramp quickly on a complex domain.

You'll work closely with the CTO on system design while maintaining ownership of implementation and operational correctness.

How We Work

We use tools such as Claude Code, GitHub Copilot, and Codex heavily throughout development. They are a normal part of how we move quickly on implementation, exploration, and iteration.

Engineers are responsible for what ships. We expect people to understand system behavior, review generated code carefully, debug failures, and maintain a high bar for reliability, security, and production quality.

We look for engineers who use AI for leverage while still owning their code end-to-end. We review meaningful changes together as a team so everyone maintains context on how the system works end-to-end.

What You'll Do

• Design and implement backend workflows and application logic
• Build and maintain APIs that power product functionality
• Implement scheduling, encounter, and operational workflows
• Build AI-powered tools that help clinicians with documentation, clinical decision support, and voice-driven workflows
• Integrate with clinical systems using FHIR
• Debug and resolve production issues across the stack
• Ensure system behavior remains predictable under failure conditions
• Collaborate with frontend engineers to maintain clear API contracts
• Use AI development tools to accelerate implementation while maintaining reliability
• Participate in system design and technical planning

Our Stack

Python (Django, async-first with django-ninja and Channels), Next.js, PostgreSQL (with pgvector), Redis, WebSockets, asynchronous background jobs, workflow state machines, and clinical integrations using Medplum and FHIR.

Our services run on AWS and Kubernetes, and we rely on Terraform for IaC and Datadog for APM and infrastructure monitoring.

We maintain automated testing and deployment pipelines using Github Actions and integrate with AI providers including Google (Vertex AI), Anthropic (AWS Bedrock), and OpenAI.

What Success Looks Like

• Workflows behave reliably in production
• System behavior remains predictable under failure conditions
• APIs remain stable and easy to reason about
• You understand how frontend behavior connects to backend execution
• You use AI tools effectively while maintaining strong ownership of system correctness
• You can debug a production issue that crosses the frontend/backend/infrastructure boundary without waiting for someone else

Requirements

• 5+ years building production software systems
• Strong Python experience.
• Familiarity with asynchronous programming in any language.
• Experience designing and maintaining APIs for production applications
• Experience building backend systems beyond request/response - background jobs, event-driven patterns, or async processing
• Strong debugging and problem-solving skills
• Ability to design systems that behave predictably when things go wrong
• Comfort working in an AI-assisted development workflow

Nice to Have

• Experience with React or NextJS
• Experience building workflow or state-machine-driven systems
• Experience reasoning about stateful systems
• Experience with FHIR or healthcare data systems (helpful but not required)
• Experience with Kubernetes or distributed systems
• Experience working in early-stage startups

What It's Like to Work with Us

We're building something ambitious, and we care deeply about how we show up while we do it.

We stay close to clinicians

We spend time with the people we serve, in their practices and in their communities. The best ideas come from understanding their reality and building alongside them.

We take responsibility and move things forward

If something matters, we don't wait for perfect clarity. We step in, make progress, and figure it out together.

We turn what works into something that lasts

We solve problems in real time, then step back and build the systems that make it easier for the next clinician.

We use AI thoughtfully

We look for ways to reduce manual work so clinicians can focus on care. If something feels repetitive, we treat it as an opportunity to improve how we operate.

We care about building something meaningful

We're here to help clinicians create independent, community-rooted practices. That responsibility shapes how we make decisions and how we grow.

We are kind, direct, and low ego

We support each other, give honest feedback, and focus on getting to the right answer. We take the work seriously, but not ourselves.

Benefits

• Competitive salary and generous, early-stage equity (4-year grant)
• Health, vision, and dental benefits
• 401(k)
• Unlimited PTO
• Prime office in Columbus Circle with weekly team lunches
• Fun team events and offsites

We aim to pay competitively for our stage and the importance of the work. Compensation includes base salary, meaningful equity, and benefits, and is designed to align long-term incentives with the impact you'll have at Kinstead. In accordance with applicable laws, we provide a reasonable estimate of the salary range for this role. Final compensation will depend on a number of factors, including experience, skillset, and leveling, as well as internal equity considerations. For this role, the estimated base salary range is $160,000 - $205,000, with most candidates falling somewhere in the middle.