Lead Full-Stack Engineer (Node/Python, React) - Overlap with EST

**About us
**We're a mental health care technology company focused on increasing access to care for Medicaid clients. We combine telehealth, clinical documentation, billing workflows, practice operations, and AI-enabled tools to help clinicians deliver care more efficiently and sustainably.We have grown quickly and are now looking for a senior technical leader who can own architecture and execution across our core platform. This person will help us improve reliability, increase performance, strengthen engineering standards, and accelerate delivery across telehealth, billing, and AI-enabled clinical workflows.

**The Role
**We are hiring a Lead Engineer, Full-Stack Node/Python to become the senior technical owner for our company's product infrastructure and core workflows.This is not a narrow feature-development role. You will be expected to deeply understand the codebase, improve architecture, solve production issues, optimize MongoDB performance, strengthen telehealth reliability, and help create the engineering foundation for the next stage of company growth.You will work closely with the CEO, clinical leadership, operations stakeholders, customer support, and implementation teams to translate real-world product issues into reliable, scalable technical solutions.

**What You’ll Own
**You will independently own technical decisions across:Architecture and design for core services, telehealth integration, workflow automation, and AI agent orchestration
Performance and reliability priorities, including instrumentation, SLOs, monitoring, incident response, and debugging playbooks
MongoDB data modeling decisions, indexing strategy, schema consistency, migrations, backfills, statuses, and data cleanup
Build-vs-buy evaluations for vendors, integrations, AI components, and infrastructure decisions
Production readiness for core workflows involving telehealth, clinical documentation, billing, audit trails, and AI-enabled automation

**What Success Looks Like in the First 90 Days
**Within your first 90 days, you will:Produce a clear 30/60/90 architecture and reliability plan based on a deep review of the codebase, MongoDB data model, indexes, and key workflows
Ship tangible improvements that increase telehealth session reliability and reduce support escalations
Improve instrumentation, logging, metrics, tracing, error handling, and incident debugging workflows
Identify and implement high-impact performance wins across MongoDB queries, backend endpoints, indexing, and caching where appropriate
Establish stronger engineering standards around PR discipline, testing expectations, CI checks, and release hygiene without slowing delivery

**What Success Looks Like After 6 Months
**After 6 months, you will have helped us:Improve telehealth reliability toward a 99%+ successful session experience, including better handling of network variability, reconnects, device issues, and real-world usage conditions
Reduce page load times and workflow execution times through data model improvements, query optimization, endpoint improvements, and performance-focused engineering
Deliver new workflows and AI agent orchestration safely in production, with evaluation, versioning, observability, fallbacks, and rollback plans
Create documentation, system diagrams, technical patterns, and onboarding materials that make it easier to hire and onboard future engineers

**Example Projects
**

**Telehealth Reliability and WebRTC Optimization
**Improve session success rate toward 99%+ by strengthening reconnect behavior, handling device and network variability, improving observability, and building support tooling. You will also ensure session timing and duration are reliably captured and mapped to billing and audit requirements.This work matters because session reliability directly impacts client outcomes, clinician trust, retention, revenue, and payer confidence.

**MongoDB Performance and Data Model Hardening
**Rewrite and introduce indexes, optimize key queries and endpoints, and improve data modeling around statuses, consistency, safe migrations, and backfills. You will address slow-loading pages and slow workflow execution while improving scale without linear infrastructure cost growth.

**Workflow Automation and AI Agent Orchestration
**Build new workflows and agent-based automation for documentation, assessments, structured outputs, and in-session support. You will help establish evaluation frameworks, quality metrics, versioning, observability, fallbacks, and safe deployment patterns. You may also explore open-source models, training, or fine-tuning readiness where there are meaningful cost or capability advantages.

Tech Stack
Languages: JavaScript/TypeScript, Node.js, Python
Frontend: React, HTML landing pages
Backend: Node.js services, Python services or workflows where appropriate
Database: MongoDB as the primary system of record
Infrastructure: AWS
CI/CD: Bitbucket Pipelines
Telehealth/WebRTC: Vonage
Claims: Claim.MD primary, Change Healthcare secondary/alternate
Communications: RingCentral
Work management/integrations: Trello
AI: Multiple model providers via API keys, evaluation workflows, and open-source model exploration

**Technical Constraints You Should Be Comfortable With
**Real-time telehealth sessions are sensitive to device, browser, and network variability. Our team currently works as expected roughly 90% of the time, and we need to move toward 99%+ reliability while continuing to ship product
Billing workflows require correct mapping of session timing, duration, claim events, and audit trails
MongoDB is the system of record. We need to maintain backward compatibility while improving schema consistency, statuses, indexes, migrations, and backfills
The platform handles sensitive clinical data and requires HIPAA-aligned security, auditability, access controls, encryption, logging, least privilege, and vendor risk awareness

**Day-to-Day Work Breakdown
**Feature development: 35%
Bug fixes and maintenance: 10%
Refactoring and technical debt: 25%
Architecture and design: 20%
Code reviews: 5%
Meetings and collaboration: 5%
DevOps and infrastructure: 0 to 5% as needed

**What We’re Looking For
**We are looking for someone who ranks highly in these areas:Ownership and accountability
System design and architecture
Production-first debugging and problem solving
Performance and scalability across data and real-time systems
Testing discipline and reliability mindset
Secondary strengths that matter include communication, product thinking, vendor integration experience, security awareness, and auditability.

**Must-Have Experience
**You should have:Proven ownership of production systems end to end, from design to build to shipping to operation
Strong Node.js backend engineering experience
Solid Python competence
Experience improving performance in production systems, especially MongoDB indexing, query optimization, and API performance
Experience with real-time systems, ideally WebRTC, or strong adjacent experience with the willingness and ability to go deep quickly
Strong observability and reliability discipline across logging, metrics, traces, incident response, and production debugging
Comfort integrating, operating, and debugging vendor APIs
A security-conscious engineering mindset, especially around sensitive data, auditability, access control, and privacy

**Not a Fit If
**This role is likely not a fit if you:Avoid ownership or need constant direction
Are not comfortable debugging production issues
Do not write tests or treat reliability as optional
Treat security, privacy, and auditability as afterthoughts
Have only frontend experience without meaningful backend ownership
Have a research-only ML background without production engineering responsibility
Prefer slow, theoretical architecture work over shipping practical improvements
Optimize only for shipping speed without improving reliability, maintainability, and system quality

**Interview Process
**Our interview process is practical and job-relevant. It includes:A technical conversation about your past ownership of production systems
A live coding exercise based on realistic backend or full-stack work
A system design session focused on telehealth reliability, billing correctness, auditability, and AI workflows
A short pair-programming session on a real slice of the stack
A final conversation focused on ownership, communication, startup fit, and technical leadership

**Communication Expectations
**This role requires strong English communication and clear technical writing. You will work cross-functionally with clinical, operations, support, and implementation stakeholders.You should be comfortable writing technical plans, explaining tradeoffs, documenting systems, and balancing async collaboration with focused sync design reviews.We move quickly, but we are also raising the reliability bar for critical healthcare workflows. The right person can ship fast while making the system more stable, observable, secure, and scalable.

**What Makes This Hire a Clear Win After One Year
**Telehealth reliability is measurably improved toward 99%+ session success with strong observability and better support tooling
Major performance bottlenecks are eliminated, with pages loading quickly and workflows executing reliably
AI workflows and agents are production-grade, evaluated, versioned, observable, and supported by safe fallback paths
Engineering standards, documentation, and architecture patterns make it easy to hire, onboard, and scale the engineering team
Our team has a stronger technical foundation for serving more clinicians, more Medicaid clients, and more complex clinical and billing workflows at scale
If you want, I can also create a shortened, candidate-facing version (this one is quite long for outbound).