Backend Software Engineer

You are joining Papa Community, a 0-to-1 venture within Papa based in San Francisco that is building virtual care for seniors. As one of the first engineers on Community, you will have the autonomy and velocity of an early‑stage startup with the advantages of a growth‑stage company, including Papa’s deep expertise serving older adults, established health plan relationships, and reliable capital.

We are looking for a founding Staff Elixir Backend Software Engineer to build Community’s technical foundation from the ground up. You will be employee #1 on Papa Community’s engineering team, reporting directly to Papa Community’s GM while receiving mentorship from Papa core’s engineering leadership.

You will own the entire technical architecture for Papa Community, making foundational decisions about system design, technology choices, and engineering practices that will define the platform for years to come.

• You will navigate complex healthcare integrations connecting EHRs, care management platforms, revenue cycle management, and patient communication tools, requiring deep expertise in FHIR, HL7, X12 and resilient API integration patterns.
• You will balance technical perfection with rapid shipping in a startup environment, using judgment to decide when to build for scale and when to ship quickly.
• You will work in a high‑autonomy setting, making recommendations to stakeholders and owning outcomes without the need for detailed requirements.

• Build the technical foundation for virtual care delivery. Design and implement the core platform that connects EHRs, care management systems, billing infrastructure, and patient communication tools, ensuring HIPAA‑compliant, scalable architecture.
• Enable operational intelligence and automation. Build data infrastructure and tooling that allow the clinical team to make informed decisions, automate care workflows, and track patient outcomes in real time.
• Lead critical technical decisions. Evaluate build vs. buy trade‑offs, recommend technology choices, and architect solutions that balance immediate needs with long‑term scalability.
• Establish engineering practices. Define code standards, testing expectations, deployment processes, and technical documentation practices, leveraging best practices from Papa core engineering.
• Own system reliability and performance. Ensure production stability, monitoring, and continuous improvement for healthcare‑critical workflows.

• Product mindset. Think like a founder, balancing technical excellence with business outcomes and patient impact.
• Strategic technical leadership. Lead large, complex projects with clear business impact and influence senior leaders on engineering strategy.
• Deep backend expertise. Expert‑level proficiency in Elixir with knowledge of distributed systems, API design, and scalable architectures.
• System design and reliability. Build resilient, well‑tested systems with proper monitoring, rollout practices, and production stability for healthcare‑critical workloads.
• High autonomy and ownership. Thrive in ambiguous environments, educate non‑technical stakeholders, and own outcomes without detailed direction.
• Startup adaptability. Communicate across operational and clinical teams, ship quickly when needed, and balance scaling considerations.
• Continuous improvement mindset. Proactively identify improvement areas in systems and processes and drive initiatives to address them.

• 10+ years of software development experience
• Expert‑level proficiency in Elixir
• Experience building and shipping high‑quality, highly reliable work
• Experience improving quality through thoughtful code reviews, comprehensive testing, appropriate rollout, and monitoring
• Passionate about improving healthcare access and outcomes

• Experience with healthcare technology, including data standards (FHIR, HL7, X12), EHR/vendor integrations, HIPAA‑compliant systems, and healthcare‑specific APIs
• Experience with Phoenix Live View

• Hybrid with 2‑3 days per week in‑office in San Francisco, CA

• Target salary range…