Founding Backend Engineer

Overview

CTO  | Building Intelligent Patient Engagement Systems | AI Infrastructure for Healthcare | Ex-CVS Health

Rivvi AI, Inc. builds conversational AI infrastructure for healthcare. The platform that health systems, payers, and life sciences companies deploy to reach patients vi powers scalable patient outreach for medication adherence, care gap closures, chronic care management, and clinical trials. The platform manages millions of patient interactions across voice and messaging without requiring EMR integrations, enabling healthcare teams to deploy in days, not months.

Our AI is talking to real patients right now. Rivvi is headquartered in Cambridge, MA and was founded in 2024.

This is a full-time on-site role based in Cambridge, MA for a Founding Backend Engineer. You will own the backend. Architect systems, build them, own the outcomes. You ll build the infrastructure layer powering millions of patient conversations. The API layer healthcare teams depend on. The AI orchestration that coordinates voice agents and LLM pipelines. The event-driven systems that turn conversations into outcomes.

Your architectural decisions will determine how fast we scale. This is founding engineer territory, not ticket-taking. You ll work directly with the founders and ship code that reaches production the same week. No layers of management. No months-long planning cycles. Build, ship, learn, repeat.

• Own the backend and architecture for Rivvi s platform.
• Architect, build, and own infrastructure powering millions of patient conversations.
• Develop the API layer used by healthcare teams.
• Design AI orchestration that coordinates voice agents and LLM pipelines.
• Build event-driven systems that convert conversations into outcomes.
• Make architectural decisions to enable rapid scaling and production readiness.
• Collaborate directly with founders; ship production code within weeks.

• 5+ years backend engineering (or 3+ years with MS in CS)
• Type Script expertise with strict mode, thinking in types, building for maintainability
• Serverless architecture experience with Lambda, event-driven patterns, or equivalent distributed systems
• Strong database fundamentals including query optimization, data modeling, and understanding tradeoffs between SQL and No
  
  SQL
• API design experience with RESTful, RPC, or Graph
  
  QL at production scale
• Comfort with AI tooling. You use Cursor, Copilot, or Claude daily to move faster.
• Healthcare or regulated industry experience is a plus
• Voice AI platforms like Retell or Vapi is a plus
• Telephony integration with Twilio or Telnyx is a plus
• LLM integration and prompt engineering at production scale is a plus

• Founding equity (0.5–2%+) with real ownership
• Salary $120K–$150K based on experience
• Comprehensive health, dental, and vision
• Equipment budget and professional development stipend
• Direct collaboration with founders on product and architecture decisions

• Mid-Senior level

• Full-time

• Engineering and Information Technology

• Hospitals and Health Care