Engineering Lead: Backend Systems & Growth

Engineering Lead: Backend Systems & GrowthAbout Medical Connect Medical Connect helps the 100M Americans who don’t have access to a primary care doctor get the care they need to focus on their health and protect their jobs. We do this by making critical health services convenient, affordable, and reliable. We are a fast-growing, ambitious company where engineering sits directly in the critical path of revenue, operations, and customer experience. The Role We’re looking for a hands-on Engineering Lead to own our backend systems and lead technical execution across a small engineering team. This is a deeply hands-on role: roughly 90% building and 10% leading. You will spend most of your time building, debugging, designing, reviewing, and shipping. The leadership component is real but focused: you will set the Junior Engineer’s priorities, review their work, unblock them when needed, and ultimately own the quality and outcomes of what they ship. Company leadership sets business priorities. You own engineering execution end-to-end: translating those priorities into technical plans, deciding how to solve them, driving execution, and delivering the intended business outcome. You will: Own our backend systems, workflow orchestration, integrations, and reliability Own the AI Form Filler and lead a Junior Engineer responsible for its execution Partner directly with Growth to ship experiments and unlock growth Partner directly with Operations to automate workflows and improve operational efficiency Work alongside our Frontend Growth Engineer and step into frontend work when needed Your success will be measured by your impact on business results, not technical sophistication. We want someone who understands that great startup engineering means identifying what matters, finding the simplest reliable solution, and shipping it quickly. What You'll Own Backend Systems & Reliability Our backend connects intake, payments, appointments, clinical operations, medical documentation, lifecycle marketing, and analytics.

• Today, that includes roughly 9 services running on Cloud Run across Go, Python, and TypeScript
• Pub/Sub and Temporal Cloud for event-driven workflows
• two Cloud SQL PostgreSQL instances
• BigQuery
• staging and production environments for each service
• and 20+ third-party integrations.

You'll own: Production reliability: Ship features that fail safely, with the testing, monitoring, CI/CD, and safeguards needed to prevent system-wide disruptions. Distributed systems: Own workflow orchestration, APIs, integrations, payments, state management, retries, idempotency, and failure recovery. Data integrity: Own reconciliation, observability, production debugging, root-cause analysis, and systemic fixes. Automation: Build reliable systems that replace manual operational workflows. Our core architecture is event-driven, using Pub/Sub and Temporal to orchestrate workflows across 20+ integrations. You'll own the reliability of these distributed workflows and inherit an active migration from our legacy model to a new domain model running side-by-side in production. We value technical excellence when it produces better outcomes. We do not value complexity for its own sake. Our codebase uses DDD/Clean Architecture, CQRS, Temporal sagas, transactional outbox patterns, projections, and strong bounded-context boundaries. You should understand these patterns well enough to review work against them while knowing when a simpler solution is appropriate. Operations Systems Airtable is the primary operating system for our Operations team. Our orchestrator projects every Medical Leave case into a Single Queue in Airtable and consumes Ops changes back into our backend through Airtable automations. You'll own this integration across mappings, rate limits, attachments, event replays, and data recovery. Replays cannot overwrite manual Ops edits, and failures often require case-by-case recovery. Attention to detail matters: a single incorrect field can create an incorrect case for our Operations team. Growth Enablement You will help Growth move quickly without breaking the systems underneath it. You'll partner directly with our Head of Growth and Frontend Growth Engineer on: Funnel, pricing, checkout, membership, and upsell experiments Analytics, conversion tracking, and ad-channel instrumentation Infrastructure that makes it faster to test, learn, and ship with data we can trust Engineering Leadership You will be responsible for the quality and execution of engineering work across the team. That means: Communicate and plan exceptionally well in writing. For non-trivial work, write through the problem, approach, and plan before implementation. Provide a concise daily update covering progress, what’s working, what’s not, and what’s next so the company always knows where engineering stands. Turn business priorities into simple, executable technical plans, making pragmatic tradeoffs between speed, scope, and quality. Set realistic commitments and communicate early when they're at risk: what happened, what changes now, and when we should expect the outcome. Manage the Junior Engineer’s priorities, review their work, and own their outcomes. Maintain the appropriate engineering quality bar while keeping projects moving without needing someone else to manage you. AI-Native Engineering AI coding agents are core to how we build. Most delivery runs through supervised Claude Code and Codex sessions using repository-level rules, guardrails, architecture tests, and multi-agent workflows. You should already be a heavy AI coding-agent user who knows how to plan, delegate, review, and independently verify agent work, not simply prompt an LLM. What Exceptional Performance Looks Like: 30-60-90 Days We expect an exceptional engineer to create meaningful impact quickly. You won't spend your first 90 days observing. You'll learn by building, take ownership as soon as you have enough context, and improve the systems and team around you as you go.First 30 Days: Take Ownership Ship your paid project to production and begin contributing meaningful production work beyond it Understand both codebases and be able to explain how a case flows end-to-end across our systems, integrations, and Operations workflows Become capable of independently diagnosing and resolving operational and production issues across our core systems Take over day-to-day engineering planning, project tracking, releases, and written communication Produce a written assessment of the most important gaps you see in our architecture, reliability, and engineering execution, including what you would fix first and why Begin addressing the highest-impact issues rather than simply documenting them Set realistic commitments, consistently deliver against them, and communicate risks early enough that there are no surprises By Day 30: You understand the system deeply enough to ship safely, resolve issues independently, identify where it needs to improve, and take meaningful engineering execution off leadership's plate.By 60 Days: Create Leverage Take full ownership of the Junior Engineer's priorities, technical direction, reviews, and output Begin systematically shipping improvements from the gap assessment you developed during your first 30 days Take ownership of a major initiative starting from an end business goal rather than a prescribed technical solution Define the technical approach, identify constraints, surface what the current system can and cannot support, and present alternative solutions with clear tradeoffs Turn that approach into a realistic execution plan and drive it through production Eliminate recurring problems through systemic fixes rather than repeatedly treating symptoms Proactively identify opportunities to improve reliability, operational efficiency, Growth velocity, or engineering speed before leadership asks By Day 60: Leadership can give you an ambiguous business outcome and trust you to determine how engineering should solve it, communicate the tradeoffs, lead the team, and drive it to completion.By 90 Days: Create a Step-Change Make engineering meaningfully faster and more reliable than the function you inherited Have shipped material improvements to our highest-priority business initiatives with measurable impact on Growth, Operations, reliability, or customer experience Reduce recurring production failures and operational engineering burden through durable, systemic improvements Create leverage through better systems, tooling, AI-agent workflows, documentation, and delegation so engineering output scales beyond your individual coding capacity Make the Junior Engineer noticeably more effective through better prioritization, delegation, technical direction, and review Develop a deep enough understanding of the business to identify high-value engineering opportunities that Growth, Operations, or leadership haven't explicitly asked for Raise the execution bar across engineering: simpler solutions, faster cycles, better planning, safer releases, clearer communication, and stronger accountability By Day 90: The difference should be obvious. Engineering ships faster, production is more reliable, the team produces more leverage, Growth and Operations move faster, and leadership can focus on what the company should accomplish rather than managing how engineering gets it done.Who We're Looking For You: Have 7+ years of software engineering experience, including at least 2 years owning event-driven production systems Have worked in startups or similarly fast-moving environments Are strong with APIs, webhooks, databases, integrations, and event-driven systems Can work across the full stack when necessary Have led or mentored other engineers Are careful with sensitive data by instinct. You have worked in healthcare, fintech, or another regulated environment, or can demonstrate the same discipline elsewhere Use AI coding agents heavily as part of your daily engineering workflow Operate with extreme ownership. Spot gaps, proactively find problems, unblock yourself, and feel responsible for the outcome even when you didn't cause the problem. Treat Growth and Operations as your customers. Understand how they actually work, including observing their workflows firsthand, before deciding what or how to automate. Are highly accountable. Make realistic commitments, do what you say you'll do, and communicate early when something is at risk. Care more about shipping something valuable than building something theoretically perfect Strong Plus You don't need to check every one of these boxes, but we'd be particularly excited if you have experience with: Shipping an LLM-backed feature to production with a human in the loop and being able to explain where it failed, what you learned, and how you improved it Building and operating production payment and subscription systems Workflow engines such as Temporal, Cadence, or Step Functions and event-driven architectures HIPAA-aware engineering and handling PHI in production systems How We Work Learn Fast and Make Good Decisions: Start with the goal, identify what matters, find the shortest viable path, test assumptions against reality, and update quickly. Hardest Working and Most Professional: Work extremely hard, stay highly available, show up prepared, keep commitments, and communicate before they're missed. We expect exceptional effort, including regularly working 60+ hours. Impacts Winning: Own outcomes, not tasks. Focus relentlessly on what moves the business forward. High Integrity: Tell the truth, surface problems early, admit mistakes, keep your word, and protect sensitive information. This Role Is Not For You If This probably isn't the right environment if you: Prefer long-term technical architecture to take priority over speed and near-term business outcomes Need clear requirements and well-defined projects before starting Prefer greenfield development over debugging and improving existing systems Want to specialize rather than work across Engineering, Growth, and Operations as needed Prefer predictable hours and firm boundaries around availability Prefer writing production code manually rather than using AI coding agents as a core part of your workflow Tech Stack Backend: Go, Python, PostgreSQL Frontend: TypeScript, Next.js Infrastructure & Data: GCP, Cloud Run, Cloud SQL, Pub/Sub, BigQuery, Cloud Build Workflow & AI: Temporal Cloud, Vertex AI (Gemini), Google Document AI Core Integrations: Stripe, Healthie, PandaDoc, AWS Cognito, Airtable Growth: Webflow, Heyflow, Klaviyo, VWO, GTM, GA, Google Ads, Meta AI Development: Claude Code, Codex, repository-level agent harnesses You don't need experience with every technology in our stack. We care much more about your ability to understand complex systems quickly, simplify them, and use technology to deliver business outcomes. Role Details Full-time, remote Significant overlap with U.S. Eastern Time Minimum 8 hour overlap with 8am-6pm est Fluent written and verbal English (must have) Direct management of a Junior Engineer High availability with high flexibility. Important production issues don't always happen during normal working hours, and we expect you to make time when something critical requires your attention. In return, you have significant flexibility in when and where you work the rest of the time. What We Offer Real ownership: You’ll have significant autonomy over how engineering problems are solved and will own a large surface area of the business. We hire people we trust to make decisions, not wait for instructions. Shape the engineering organization: You’ll have a major role in defining our technical direction, engineering standards, tooling, and how the team operates as we scale. Work directly with the founders: You’ll work closely with company leadership, with very little distance between identifying an opportunity and getting something into production. High-impact work: Engineering sits directly in the critical path of growth, operations, and customer experience. The things you build will have visible, measurable impact on the company. Fully remote: Work from wherever you’re most productive. Own your schedule: The pace is intense and expectations are high, but we care about outcomes rather than when or where you work. Manage your time and calendar in the way that makes you most effective. Flexible time off: Take a minimum of two weeks off each year, with no maximum. We measure performance based on outcomes, not days at your desk. Performance upside: Exceptional contributions, high-value projects, and major milestones may be recognized with additional performance bonuses. Job Type: Full-time Application Question(s): What interested you in this role? Why do you think you’re a strong fit? Based on the job description, what do you think will be the hardest part of this role for you, and why? Describe one production system you owned end-to-end. What business metric did it affect? What broke while you owned it, and what did you change so it wouldn't break the same way again? Please submit a short video to demonstrate your english proficiency. Answer the question: "Tell us about the most technically challenging thing you’ve personally built. What did you personally own, what made it difficult, and what was the outcome?" Tell us about a time you cut scope to hit a deadline. What did you cut, how did you decide, and what happened afterward? How do you use AI in your engineering workflow today? Be specific about the tools you use and how you use them. Work Location: In person