Senior Backend Engineer, Workflow Systems Location: New York City (Hybrid, 3 days in office per week)Kinstead is building the AI-native operating system for independent healthcare, enabling nurse practitioners to launch and run their own clinics. We replace the fragmented, manual infrastructure behind healthcare with a single, intelligent system so clinicians can spend their time on care, not paperwork.This creates a new model of care, one where clinicians practice on their terms and patients get consistent, community-rooted care. We’re backed by Wisdom Ventures and founders and executives from Pomelo Care, Flatiron Health, Roivant, and PathAI on our mission to deliver better care.About the RoleWe’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 WorkWe 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 DoDesign and implement backend workflows and application logicBuild and maintain APIs that power product functionalityImplement scheduling, encounter, and operational workflowsBuild AI-powered tools that help clinicians with documentation, clinical decision support, and voice-driven workflowsIntegrate with clinical systems using FHIRDebug and resolve production issues across the stackEnsure system behavior remains predictable under failure conditionsCollaborate with frontend engineers to maintain clear API contractsUse AI development tools to accelerate implementation while maintaining reliabilityParticipate in system design and technical planningOur StackPython (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 LikeWorkflows behave reliably in productionSystem behavior remains predictable under failure conditionsAPIs remain stable and easy to reason aboutYou understand how frontend behavior connects to backend executionYou use AI tools effectively while maintaining strong ownership of system correctnessYou can debug a production issue that crosses the frontend/backend/infrastructure boundary without waiting for someone elseRequirements5+ years building production software systemsStrong Python experience.Familiarity with asynchronous programming in any language.Experience designing and maintaining APIs for production applicationsExperience building backend systems beyond request/response — background jobs, event-driven patterns, or async processingStrong debugging and problem-solving skillsAbility to design systems that behave predictably when things go wrongComfort working in an AI-assisted development workflowNice to HaveExperience with React or NextJSExperience building workflow or state-machine-driven systemsExperience reasoning about stateful systemsExperience with FHIR or healthcare data systems (helpful but not required)Experience with Kubernetes or distributed systemsExperience working in early-stage startupsWhat It's Like to Work with UsWe’re building something ambitious, and we care deeply about how we show up while we do it.🤝 We stay close to cliniciansWe 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 forwardIf 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 lastsWe solve problems in real time, then step back and build the systems that make it easier for the next clinician.🤖 We use AI thoughtfullyWe 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 meaningfulWe’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 egoWe support each other, give honest feedback, and focus on getting to the right answer. We take the work seriously, but not ourselves.BenefitsCompetitive salary and generous, early-stage equity (4-year grant)Health, vision, and dental benefits401(k)Unlimited PTOPrime office in Columbus Circle with weekly team lunchesFun team events and offsitesAt Kinstead, we’re building infrastructure for healthcare that serves entire communities—not just a narrow slice of them. That requires a team with diverse perspectives, lived exp