Founding Backend Engineer - Core Platform

Healthcare documentation is broken. Nestmed is fixing it with an AI platform that gives clinicians their time back.

In just one year, we’ve scaled to support tens of thousands of clinicians across more than a million patient visits. We're now the trusted partner for over 60 home health agencies, including 7 of the top 10 enterprises in the US.

Our founding team—hailing from Stanford, YC, Google, and Meta—is backed by the founders of PayPal and Plaid to build the essential infrastructure for the future of the $500B home healthcare industry.

You'll be the founding engineer rebuilding the core of an EMR for healthcare that is AI-native from the ground up. We've spent two years building an understanding of healthcare workflows deeply and now we need to productize these learnings into a scalable platform that can handle the massive demand we're seeing.

As the founding Backend Engineer on our Core Platform team, you'll architect the foundational data models and distributed systems that power post-acute care for the next decades to come. You'll design database schemas that can handle complex clinical workflows, build event-driven architectures that process millions of patient interactions, and create the underlying infrastructure that allows healthcare organizations to configure their unique requirements without custom engineering work.

This is systems engineering at scale: you'll be working with troves of clinical data, designing fault-tolerant distributed systems, and building the data modeling foundations that every other engineering team depends on. You'll start as the solo engineer on this critical infrastructure and grow it into a robust team handling our core platform

• Architect next-generation healthcare data models that can represent complex clinical workflows across home health, skilled nursing, rehab facilities, and hospice care

• Design distributed systems and event architectures that process millions of patient visits with sub-second latency and 99.99% reliability

• Build configurable workflow engines using robust data modeling and microservices architecture to eliminate the need for custom implementations

• Scale production databases and caching layers to handle exponential growth from thousands to millions of concurrent clinical sessions

• Implement healthcare data pipelines that handle HL7 FHIR, EDI transactions, and real-time clinical data ingestion at enterprise scale

• Design fault-tolerant systems with comprehensive monitoring, automated failover, and disaster recovery for healthcare-critical workloads

• Collaborate with clinical engineers to translate complex healthcare requirements into scalable database schemas and API contracts

• Build the platform foundation that every other engineering team will build upon, from AI agents to clinical workflows

• 5+ years of backend engineering experience building scalable platforms and distributed systems from scratch

• Deep expertise in database design and data modeling for complex, multi-tenant systems with strict consistency requirements

• Production experience with distributed systems including event-driven architectures, microservices, and handling high-throughput data pipelines

• Strong foundation in systems design with experience scaling databases, caching layers, and API architectures to millions of requests

• Healthcare data experience (HL7 FHIR, EDI) or other highly regulated industries with complex compliance requirements is strongly preferred

• Track record as a founding platform engineer or early engineer who built core infrastructure that scaled to large engineering teams

• Experience with cloud infrastructure (AWS preferred) and Infrastructure-as-Code for production healthcare systems

• San Francisco-based and excited about leading platform architecture decisions in an in-person environment

Healthcare infrastructure has been built on 30-year-old assumptions. You'll be architecting the foundational systems that will power AI-native healthcare for millions of patients. Every database schema you design and every API you architect will multiply across thousands of healthcare providers.

You'll start as the founding platform engineer and grow this into a world-class infrastructure team. Join us in San Francisco to build the core systems that will transform healthcare delivery at scale.

If you’re passionate about building high-impact products that solve real-world problems, we’d love to hear from you. Apply today!