Legion Health
Founding Engineer | AI-Native Ops Infrastructure
Legion Health, San Francisco, California, United States, 94199
Join to apply for the
Founding Engineer | AI-Native Ops Infrastructure
role at
Legion Health
Base pay range $130,000.00/yr - $180,000.00/yr
About Legion Health Legion Health (YC S21) is building the
AI-native operations layer for psychiatric care . We run our own psychiatric practice and are rebuilding what happens
outside
the visit—scheduling, intake, documentation, billing, risk detection, and coordination. Not “doctor-in-a-box,” but the operational backend that mental health actually runs on. Our agent infrastructure already supports 2,000+ patients with one human support lead. The systems you build will land in real clinical workflows immediately.
Role: Founding Engineer – AI-Native Ops Infrastructure (In-Person SF) Hey—I’m Daniel, co-founder & CTO. I’m hiring a
Founding Engineer
to own core backend + agent systems end-to-end.
You’ll help design and build the infrastructure that coordinates human clinicians, support staff, and AI agents like a single, coherent system. Roles evolve quickly here—including mine. I’m looking for someone who wants to
grow into owning major parts of the system , not someone depending on me to stay in a narrow CTO role forever.
Responsibilities
Own our event-driven backend – architect and scale our Node.js / TypeScript / Supabase (Postgres) / AWS stack. Design schemas, invariants, and workflows that encode how psychiatric care actually operates. Turn messy real-world processes into clean state machines and event streams.
Build real LLM agents as coworkers – implement tool use, retries, memory, and safety rails. Design action schemas and evaluation loops so agents can run reliably in production. Work on orchestration, context management, and multi-step workflows.
Shape human + AI ops UX – build internal tools used by both humans and agents. Make it trivial to see “what happened, why, and what should happen next” in any patient journey.
Define world-state & simulation – model the canonical state of a patient’s journey across time. Power alerting, routing, and decision-making from that live simulation.
Own data, safety & compliance – engineer HIPAA-compliant pipelines for transcripts, events, and EHR data. Ensure PHI access, agent actions, and human overrides are all auditable.
Drive architecture & strategy – work directly with me to debate tradeoffs, define new primitives, and decide what we build next.
Qualifications & Fit
Owned real systems 0→1 or 1→N, not just tickets.
Think in events, state, and invariants, not just CRUD endpoints.
Either already LLM-fluent or a strong systems/backend engineer who can get dangerous fast.
Care about velocity and correctness – moving quickly while keeping things understandable and robust.
Like small, high-candor teams and direct feedback.
Want to see your work go live in production weekly, not sit on a roadmap.
Nice to have (but not required)
Experience with Node.js / TypeScript, Postgres, or Supabase.
Experience with LLMs, agents, tool-calling, or RAG.
Experience in healthcare, fintech, or other regulated / high-stakes domains.
Experience in early-stage startups or founding teams.
Our Stack
Backend: Node.js, TypeScript, Supabase (Postgres), AWS (ECS, Lambda, S3)
Frontend: Next.js 15 (App Router), Tailwind, Vercel
AI: OpenAI, Anthropic, tool-calling agents, embeddings + vector DBs, Langfuse-style observability
Other: PHI security, audit trails, real-time schedulers, transcript ingestion
Interview Process
Intro call (20–30 min) with Daniel – background, what you’ve built, what you want.
Systems / portfolio deep dive (45–60 min) – walk through 1–2 systems you’ve shipped; architecture, tradeoffs, failure modes.
Practical work trial (1–2 hours async) – short, realistic backend/LLM-systems exercise. No leetcode, no puzzles.
Final onsite (1–2 hours) – meet the team, pair on a real issue, and talk through how you’d own a domain. We aim to go from first conversation to offer in 7–10 days.
Compensation
Salary: $130,000–$180,000 (depending on experience)
Equity: 0.2%–0.8% meaningful early ownership
In-person in San Francisco
Seniority Level Mid-Senior level
Employment type Full-time
Job function Engineering and Information Technology
Industries Mental Health Care
Referrals increase your chances of interviewing at Legion Health by 2x
#J-18808-Ljbffr
Founding Engineer | AI-Native Ops Infrastructure
role at
Legion Health
Base pay range $130,000.00/yr - $180,000.00/yr
About Legion Health Legion Health (YC S21) is building the
AI-native operations layer for psychiatric care . We run our own psychiatric practice and are rebuilding what happens
outside
the visit—scheduling, intake, documentation, billing, risk detection, and coordination. Not “doctor-in-a-box,” but the operational backend that mental health actually runs on. Our agent infrastructure already supports 2,000+ patients with one human support lead. The systems you build will land in real clinical workflows immediately.
Role: Founding Engineer – AI-Native Ops Infrastructure (In-Person SF) Hey—I’m Daniel, co-founder & CTO. I’m hiring a
Founding Engineer
to own core backend + agent systems end-to-end.
You’ll help design and build the infrastructure that coordinates human clinicians, support staff, and AI agents like a single, coherent system. Roles evolve quickly here—including mine. I’m looking for someone who wants to
grow into owning major parts of the system , not someone depending on me to stay in a narrow CTO role forever.
Responsibilities
Own our event-driven backend – architect and scale our Node.js / TypeScript / Supabase (Postgres) / AWS stack. Design schemas, invariants, and workflows that encode how psychiatric care actually operates. Turn messy real-world processes into clean state machines and event streams.
Build real LLM agents as coworkers – implement tool use, retries, memory, and safety rails. Design action schemas and evaluation loops so agents can run reliably in production. Work on orchestration, context management, and multi-step workflows.
Shape human + AI ops UX – build internal tools used by both humans and agents. Make it trivial to see “what happened, why, and what should happen next” in any patient journey.
Define world-state & simulation – model the canonical state of a patient’s journey across time. Power alerting, routing, and decision-making from that live simulation.
Own data, safety & compliance – engineer HIPAA-compliant pipelines for transcripts, events, and EHR data. Ensure PHI access, agent actions, and human overrides are all auditable.
Drive architecture & strategy – work directly with me to debate tradeoffs, define new primitives, and decide what we build next.
Qualifications & Fit
Owned real systems 0→1 or 1→N, not just tickets.
Think in events, state, and invariants, not just CRUD endpoints.
Either already LLM-fluent or a strong systems/backend engineer who can get dangerous fast.
Care about velocity and correctness – moving quickly while keeping things understandable and robust.
Like small, high-candor teams and direct feedback.
Want to see your work go live in production weekly, not sit on a roadmap.
Nice to have (but not required)
Experience with Node.js / TypeScript, Postgres, or Supabase.
Experience with LLMs, agents, tool-calling, or RAG.
Experience in healthcare, fintech, or other regulated / high-stakes domains.
Experience in early-stage startups or founding teams.
Our Stack
Backend: Node.js, TypeScript, Supabase (Postgres), AWS (ECS, Lambda, S3)
Frontend: Next.js 15 (App Router), Tailwind, Vercel
AI: OpenAI, Anthropic, tool-calling agents, embeddings + vector DBs, Langfuse-style observability
Other: PHI security, audit trails, real-time schedulers, transcript ingestion
Interview Process
Intro call (20–30 min) with Daniel – background, what you’ve built, what you want.
Systems / portfolio deep dive (45–60 min) – walk through 1–2 systems you’ve shipped; architecture, tradeoffs, failure modes.
Practical work trial (1–2 hours async) – short, realistic backend/LLM-systems exercise. No leetcode, no puzzles.
Final onsite (1–2 hours) – meet the team, pair on a real issue, and talk through how you’d own a domain. We aim to go from first conversation to offer in 7–10 days.
Compensation
Salary: $130,000–$180,000 (depending on experience)
Equity: 0.2%–0.8% meaningful early ownership
In-person in San Francisco
Seniority Level Mid-Senior level
Employment type Full-time
Job function Engineering and Information Technology
Industries Mental Health Care
Referrals increase your chances of interviewing at Legion Health by 2x
#J-18808-Ljbffr