Founding Backend Engineer - AI Agents

About Nestmed

Nestmed is redefining post-acute healthcare with AI-driven technology that helps clinicians work more efficiently and provide better patient care.

Within one year, we've processed over half a million patient visits, with tens of thousands of clinicians using our product daily. We're now working with 7 of the top 10 post-acute healthcare enterprises in the U.S., helping shape the future of home healthcare delivery.

Founded by Stanford and YC alumni with deep healthcare and AI expertise, our founding team combines years of clinical experience with cutting-edge technical backgrounds from companies like Amazon, Google, Meta, and leading healthcare organizations. Backed by top investors including SciFi VC (Max Levchin, PayPal co-founder) and Mischief Capital (Plaid founder), we're building the next generation of healthcare infrastructure.

About the Role

Clinicians spend 80% of their time on manual administrative work that could be automated. As the founding Backend Engineer on our AI Agents team, you'll build AI agents for better patient care and to support providers by eliminating this administrative burden, allowing healthcare providers to focus entirely on patient care.

You'll develop AI agents that handle everything from complex scheduling coordination with hospitals and primary care doctors to quality assurance reviews and medical coding. These aren't simple chatbots—they're sophisticated multi-step workflows that understand healthcare context, integrate with multiple systems, and make autonomous decisions that directly impact patient outcomes.

Beyond administrative automation, you'll build clinician support agents that identify at-risk patients, proactively follow up with families, and provide real-time insights that help providers deliver 10x better care. This is AI engineering at its most impactful: your code will directly improve healthcare delivery for thousands of patients.

You'll start as the founding engineer building autonomous healthcare agents and grow this into a specialized team of AI engineers focused on clinical workflow automation.

What You'll Do

• Design and build autonomous AI agents that execute complex healthcare workflows end-to-end, from patient scheduling to clinical documentation and quality assurance

• Develop multi-step workflow orchestration systems that coordinate between LLMs, external APIs, and business logic to handle tasks like insurance authorization and care coordination

• Build state machines and workflow engines that can handle complex branching logic, error recovery, and human-in-the-loop interventions for clinical decision-making

• Implement intelligent patient monitoring systems that analyze clinical data streams to identify risks and automatically trigger appropriate care interventions

• Create robust integration layers with EMRs, scheduling systems, communication platforms, and insurance APIs using HL7 FHIR and EDI standards

• Design agent orchestration frameworks that can spawn, monitor, and coordinate hundreds of concurrent AI agents processing different patient cases

• Build comprehensive observability and control systems that provide clinicians visibility into agent decisions and the ability to override when necessary

• Collaborate with clinical teams to understand complex care workflows and translate them into reliable automated processes

What You Bring

• 5+ years of backend engineering experience with focus on workflow automation, state machines, or distributed systems

• Strong AI/ML engineering background with production experience deploying and orchestrating LLMs, including prompt engineering and model fine-tuning

• Experience building workflow orchestration systems using frameworks like Temporal, Airflow, or custom state machine implementations

• Understanding of healthcare workflows or other complex, regulated industries with multi-stakeholder coordination and compliance requirements

• Proficiency in Python and experience with AI frameworks, vector databases, and building reliable AI systems that handle edge cases gracefully

• Track record building autonomous systems that make decisions with minimal human intervention while providing clear audit trails and intervention points

• Experience with API integrations and building systems that coordinate between multiple external services with different reliability characteristics

• San Francisco-based and excited about working closely with clinical teams to understand real-world healthcare workflows

Why This Role Matters

You'll be building AI agents that eliminate hours of administrative burden from every healthcare provider's day, allowing them to focus on patient care. Your agents will directly improve patient outcomes by ensuring better care coordination, proactive monitoring, and more efficient healthcare delivery.

You'll start as the founding AI agents engineer and build this into a world-class automation team. Join us in San Francisco to define how AI agents integrate into healthcare workflows at scale.

If you’re passionate about building high-impact products that solve real-world problems, we’d love to hear from you. Apply today!