Senior Backend Engineer
Location: Grand Rapids, MI preferred / Remote
Experience: 7+ years
Compensation: Competitive salary + meaningful equity
Why now
EHRs 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 decade
The problem
We'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 first
Graph 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 work
We'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 have
- Deep distributed systems experience — years of doing this, not reading about it
- Shipped with AI-assisted workflows and can show how you actually work now
- Event-driven architecture depth — Kafka, not "or similar"
- Strong opinions about architecture decisions compounding when implementation is cheap
Also great if you have
- Healthcare/HIPAA experience
- Graph database or graph RAG experience
- Been a founder or early-stage engineer
- Been paged at 2am and have opinions about why
Why Healiom
Pre-Series A. 12 engineers. Real equity. Architectural influence from day one.
