Senior Software Engineer Backend (NYC) Flagler Health is building the clinical operating system for modern musculoskeletal care.We partner with MSK provider groups and specialty clinics to help them grow, operate more efficiently, and deliver better longitudinal care across patient acquisition, clinical workflows, and ongoing patient engagement. Our platform sits at the intersection of care delivery and clinic operations, helping providers capture more value across the full patient lifecycle.We’ve recently raised our Series B and are entering our next phase of growth. We’re hiring a Head of Marketing to build and scale the marketing engine that will drive that growth.This is a pipeline and revenue role. Success means generating high-quality pipeline from the right provider groups, and helping convert that into revenue in a complex, trust-driven market.Key ResponsibilitiesDesign, build, and maintain backend services and web applicationsWork on real-time web applications for audio and SMS communications with users (patients)Implement and operate fault-tolerant, long-running workflows for asynchronous and background processingCollaborate with frontend, product, and infrastructure teams to deliver reliable, compliant systemsRequired QualificationsProven experience building highly available backend applications in a regulated environment (e.g., healthcare, finance, compliance-driven SaaS)Proficiency in TypeScript and/or Python for backend service developmentExperience interacting with backend APIs built using Node.js, Express, Mongoose, Twilio or similar frameworksExperience with Temporal or similar distributed workflow orchestration systems (e.g., Cadence, AWS Step Functions, Conductor)Solid understanding of distributed systems fundamentals, including retries, idempotency, and failure handlingPreferred QualificationsExperience in healthcare technology or SaaS platforms at a medium-sized startupFamiliarity with HL7, FHIR, or EHR integrationsExperience with cloud platforms such as AWS, Azure, or GCPHands-on experience with CI/CD pipelines, infrastructure automation, and version control systems (e.g., Git)Experience working in a monorepo setup (e.g., Turborepo, Nx)Nice to have: Experience with distributed data or batch processing frameworks (e.g., Apache Spark, Databricks, or similar)Nice to have: Exposure to DevOps practices, including containerization, observability, and deployment automationWork EnvironmentThe team is distributed remotely, with regional hybrid offices in NYC and Vancouver, Canada.Hybrid. Regular and consistent on-site presence is required for this position.We have video on for our weekly team syncs and pair-coding/tech discussions. Camera is required to be on during meetings.Application ProcessApply to any one of the postings for this job. All applications from different job aggregators go to one ATS and are deduped internally.Interviews:Flagler intro:Q&A about who we/you are looking for in a new team member/teamTechnical assessments:2-3 (a mix of interview and take-home) depending on the candidate level. No Leetcode. AI allowed.Non-technical interviews with ops & c-suites: as many as you would like to get a sense of the companyOffer & background checkOur valuesThis is what you can expect of your teammates at Flagler:Persistence + ownership of outcomes: We wear many hats and aren’t afraid to run through walls to solve hard problems.Personal + professional growth: We push ourselves to learn new things and embrace challenges, even if it means that we sometimes fail.Don’t take things personally: We value and react quickly to constructive feedback.Speed is our ally: In the fast-paced world of startups, we understand the value of moving swiftly. We thrive on the adrenaline of working rapidly.Be Right: We are highly detailed oriented and try to be right, a lot.