Founding Principal Engineer - Healthcare Technology

Founding Principal Engineer – Healthcare Technology - 3 days per week in the office We're partnering with a fast-growing healthcare technology company that is reimagining how children and families access mental healthcare. With demand for pediatric behavioral healthcare significantly outstripping access, families can face long waiting lists, high costs, and a fragmented care experience. This company is building a modern care platform designed to change that — combining technology, virtual care, and physical clinics to make high-quality mental healthcare more accessible. Following a recent round of funding, they are looking for a Founding Principal Engineer to become one of the most senior technical hires in the business and help define the next generation of their technology platform. This is a highly hands-on role for an experienced engineer who wants significant ownership across architecture, product, AI, and engineering execution. Why Join? 🔹 Become a foundational engineering hire – You'll have an unusually high level of influence over the company's technical direction, architecture, engineering standards, and product development. 🔹 Build technology with meaningful real-world impact – The platform directly supports children, families, clinicians, and care teams navigating mental healthcare. 🔹 Own systems end-to-end – You'll operate at Staff/Principal level while remaining deeply hands-on, taking products and systems from initial problem through architecture, implementation, deployment, and iteration. 🔹 Help shape an AI-enabled healthcare platform – You'll have the opportunity to implement AI and LLM capabilities within real production healthcare workflows rather than simply experimenting with prototypes. 🔹 Work directly with company leadership – You'll work closely with the leadership team on both product and technical decisions, with the autonomy to influence what gets built as well as how it's built. The Role As a Founding Principal Engineer, you'll take significant ownership of the company's technical platform as the business enters its next stage of growth. You'll design and build production systems across the stack using TypeScript, Node.js, React, and AWS, while helping establish the architectural foundations and engineering practices required to scale. This is not a narrowly defined implementation role. You'll be expected to understand problems from the perspective of patients, clinicians, and the business; make pragmatic product and UX decisions; and turn ambiguous requirements into high-quality production software. You'll also help lead and direct a distributed engineering team while remaining a highly active individual contributor. What You'll Be Doing ✅ Design, build, and own production systems across the full technology stack. ✅ Make major architectural and technical decisions as the platform scales. ✅ Build full-stack applications using TypeScript, Node.js, React, and AWS. ✅ Implement AI and LLM-powered capabilities within real-world production workflows. ✅ Build reliable software within a highly regulated healthcare environment. ✅ Own technical projects from initial product thinking through architecture, implementation, deployment, and iteration. ✅ Work closely with leadership and clinical stakeholders to translate complex operational needs into intuitive product experiences. ✅ Make product and UX decisions without relying on highly detailed specifications or PRDs. ✅ Provide technical leadership and direction to distributed/offshore engineering teams. ✅ Establish engineering standards, development practices, and technical foundations for the next stage of company growth. ✅ Remain deeply hands-on while operating with the scope and ownership expected of a Staff/Principal-level engineer. What We're Looking For ✅ 6–15 years of full-stack software engineering experience, with significant ownership of production systems. ✅ Recent experience within an early-stage or high-growth startup environment, ideally as a Senior, Staff, Principal, or Founding Engineer. ✅ Strong production experience with TypeScript, Node.js, React, and AWS. ✅ Demonstrated ability to own systems end-to-end, from architecture and product decisions through implementation and operation. ✅ Experience building software within regulated environments, such as healthcare, fintech, or other industries with significant data/privacy requirements. ✅ Hands-on experience implementing AI/LLM functionality in production systems. ✅ Experience providing technical leadership to distributed or offshore engineering teams. ✅ Strong product instincts and the ability to make sensible product and UX decisions when requirements are ambiguous. ✅ Comfortable operating as a senior individual contributor in an environment where speed, pragmatism, and ownership matter. Particularly Valuable Experience building technology in healthcare, digital health, behavioral health, or HIPAA-regulated environmentsPrevious experience as an early or founding engineerStaff or Principal-level engineering experienceExperience taking startup platforms through significant periods of growthProduction AI/LLM implementation experienceExperience leading distributed engineering teamsAn active GitHub profile or personal project portfolio demonstrating hands-on engineering ability Technology Stack Languages: TypeScript Backend: Node.js Frontend: React Cloud: AWS Focus: Full-stack product engineering, healthcare technology, AI/LLMs, scalable production systems Location & Package 📍 Location: New York City 🏢 Working Model: Hybrid – 3 days per week in the office 💰 Base Salary: $200K–$250K