engineering
Posted Dec 8, 2025Founding Engineer | 👨🏻‍💻 Automonous Medical Care (backed by Y Combinator, $5M+ ARR, $20M+ raised)
San Francisco, United StatesOn-site
Responsibilities
- 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.
- 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.
Requirements
- 🧠ABOUT LEGION HEALTH At Legion Health https://legionhealth.com/, we believe everyone deserves fast, affordable, and world-class health care, and we’re developing the AI infrastructure to deliver it ourselves at world scale.
- Legion is building autonomous medical care (the AI doctor), starting with psychiatry.
- Our AI-native care-delivery platform currently automates 95% of the administrative work required for us to deliver direct patient care.
- We also recently became the first company ever to receive regulatory authorization to let AI prescribe psychiatric medications https://nypost.com/2026/03/27/business/artificial-intelligence-can-now-prescribe-mental-health-drugs/, allowing us to not only collapse health care’s admin costs but also its clinical labor costs—shifting this industry’s economics from humans to tokens.
- Our technical moat is hard to copy—we combine rich data, production AI, doctors in the loop, and end-to-end care operations to deliver measurably better care to a clinically complex patient population.
- Join us as we build the future of health care: faster, higher-quality, and more affordable, powered by doctors and AI working together. 🚀 ROLE: FOUNDING ENGINEER – AI-NATIVE MENTAL HEALTH CARE (IN-PERSON IN SF) Hey—I’m Daniel Wilson https://www.linkedin.com/in/danielgwilson/, co-founder & CTO at Legion.
- I studied applied math + CS at Princeton, then led the Office Scripts + Power Automate integration at Microsoft—shipping the highest retention-driving feature in the product.
- Before that, I did deep learning + RL research.
- I’m obsessed with building AI systems that make real workflows cleaner, safer, and more autonomous.
- You’ll build the layer that coordinates patients, clinicians, and AI agents as one coherent machine—tight feedback loops, high standards, and real ownership.
- I’m looking for someone who wants to carry real weight, take full ownership, and grow into running major parts of the system—not someone who needs a perfectly scoped box to operate inside. ✅ WHAT YOU’LL DO - Own our event-driven backend – Architect and scale our Node.js / TypeScript / Supabase (Postgres) / AWS stack.
- Work on orchestration, context management, and multi-step workflows. - Shape human + AI ops UX – Build internal tools used by both humans and agents.
- You don’t need to be a pure backend engineer—we value great product engineers who can learn fast, make strong simplifying decisions, and grow into owning backend/agent systems.
- 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.
- đź’» OUR TECH 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 đź“ť HOW TO APPLY AND HIRING PROCESS - Apply here: https://jobs.ashbyhq.com/legionhealth/ffdd2b52-eb21-489e-b124-3c0804231424 - Overview of our hiring process: 1.
- Practical work trial (1.5 hours) – short, realistic backend/LLM-systems exercise.
Benefits
- While the last generation of healthcare startups made the existing system incrementally more efficient, Legion is rebuilding full-stack care delivery from first principles.
- Our vision? A 10X better patient
- Legion Health is backed by Y Combinator, leading venture capital firms, and founders from Function Health, Modern Health, Everly Health, Trusted Health, Clipboard Health, PatientPing, Sesame Care, Faire, EasyPost, and fuboTV.
- This isn’t “just infra.” It’s building the product heart of an autonomous care system: the workflows, the agent behaviors, the guardrails, the integrations, the UX that makes it usable, and the reliability that makes it trusted.
- Final onsite (1.5 hours) – meet the team, pair on a real issue, and talk through how you’d own a domain. - Estimated time-to-hire: 7–10 days - Start date: ASAP 📍 ROLE LOGISTICS, COMPENSATION, AND
- Experience Level: Doesn’t matter if you’re cracked - US Visa Sponsorship: Yes - Salary: Competitive - Early-Stage Equity: 0.2%–0.8% meaningful early ownership - Health Insurance: Medical, dental, and vision
- benefits - Additional Perks: In-person retreats, meal stipends, etc.
- - Time Off: Flexible, unlimited vacation policy - Work Hours: Flexible but demanding because we're literally saving lives - Work Setup: In-person @ San Francisco HQ - Impact: Work on something that truly matters to millions of patients and families.
- 🤝 EQUAL EMPLOYMENT OPPORTUNITY Legion Health is proud to be an Equal Opportunity Employer.
Contact
- Github: https://github.com/danielgwilson I’m hiring a Founding Engineer to own core product + agent systems end-to-end.
Additional details
- This has helped us produce 25K+ total visits in just 2 years, all while holding ops costs flat and achieving industry-leading patient NPS and retention.
- experience that’s higher quality, less expensive, and more scalable than ever before. And a 10X better clinician
- experience that frees our providers to focus on what matters most: caring for patients.
- 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.
- 🏆 YOU MIGHT BE A FIT IF… - You’ve owned real systems 0→1 or 1→N, not just tickets.
- - You think in events, state, and invariants, not just CRUD endpoints.
- - You care about velocity and correctness—moving quickly while keeping things understandable and robust.
- - You like small, high-candor teams and direct feedback.
- - You want to see your work go live in production weekly, not sit on a roadmap. 🧰 NICE TO HAVE -
- Systems/portfolio deep dive (45 min) – walk through 1–2 systems you’ve shipped; architecture, tradeoffs, failure modes. 2.