Senior Application Engineer; Full-Stack

Senior Application Engineer (Full-Stack)

Location:

Ann Arbor, MI

Reports to:

Chief Technology Officer

Town Square Health is reimagining what healthcare can be. We’re building a first-of-its-kind value-based care model with a singular mission: to set the gold standard for how Americans experience healthcare. Our primary care locations offer comprehensive primary care with coordinated specialty support for Medicare-eligible patients, and we’re growing fast, with expansion into multiple markets on the horizon.

Our model puts a primary care physician and a dedicated Care Navigator at the center of each patient’s care, backed by AI agents that handle the coordination work that traditionally required layers of staff handoffs. We operate under value-based care contracts, which means we succeed when our patients stay healthy, not when we bill more. Our first clinic opens in Rochester, NY, with regional and then national expansion to follow.

If you’re bold, collaborative, and driven to make a real difference in people’s lives, we’d love to have you on our team!

This is not a typical senior engineering role. Town Square Health is seeking a Senior Application Engineer to join our small team working on Square One, our custom care delivery and patient engagement platform. You’ll work directly with the CTO and a small distributed engineering team, alongside an external design and development partner. The surface area is wide, the stakes are real, and the work directly shapes how clinicians and Care Navigators serve patients every day.

We are an AI-native company: AI is in the product (agents supporting PCPs and Navigators) and in how we build, where we expect fluent, judgment-driven use of AI development tools. The ideal candidate is a senior full-stack engineer who ships production web applications with strong Type Script, React, and Node experience, has hands‑on fluency building with LLM APIs, and is excited to work in performance‑critical Rust services.

• Build and ship features that directly support how clinicians and Care Navigators deliver care
• Work on AI-powered workflows that are core to the TSH care model, not a side project
• Operate with real ownership and autonomy on a small, high-trust engineering team
• Help establish the engineering practices that will scale with the organization
• Contribute to a platform that will evolve as we grow from one clinic to many

You’ll work across the full stack of Square One, TSH’s custom care delivery and patient engagement platform. This means owning features end to end, integrating with clinical systems, building AI-powered workflows, and helping shape how the engineering team operates as we scale. Small team, meaningful ownership, and work that connects directly to patient outcomes.

• Design, build, and ship full-stack features across Square One’s product areas:
  Patient, Clinical, Analytics, and Internal Tools
• Work directly with clinical and operations leaders to translate care workflows into product

• Build AI-powered workflows on Temporal, including agentic task handling and care coordination automation
• Apply judgment-driven use of AI development tools to move quickly without compromising quality

• Integrate with Athena via its APIs for scheduling, clinical documentation, and operational data
• Contribute to core backend services written in Rust

• Help establish engineering practices, including code review, testing, CI/CD, and observability, that will scale as the team grows

You’re a senior engineer who ships. You’re comfortable with ownership and ambiguity, and you ask why before you build what. You bring strong technical instincts and the product judgment to know when something is good enough to ship and when it isn’t. You’re fluent with AI development tools and use them as a force multiplier, not a crutch.

You’re energized by the challenge of building something from scratch on a small team, where your decisions have real consequences and your contributions are visible. You communicate clearly, collaborate well,…