Founding Backend Engineer
Build the infrastructure layer powering millions of patient conversations. Own the APIs, AI orchestration, and data systems that healthcare organizations depend on.
What you’ll do
- ▸Design and build the API layer — Hono.js on Lambda, type-safe RPC, sub-100ms responses at scale
- ▸Orchestrate AI agent workflows — voice AI, LLM pipelines, real-time conversation intelligence
- ▸Build event-driven systems — SQS, Step Functions, EventBridge powering millions of automated workflows
- ▸Own the data layer — PostgreSQL and DynamoDB handling millions of patient records with sub-second queries
- ▸Ship HIPAA-compliant systems — encryption, audit logging, PHI handling done right from day one
- ▸Make architecture decisions that matter — you'll shape how we build, not just what we build
Requirements
- ▸5+ years backend engineering (or 3+ years with MS in CS)
- ▸TypeScript expertise — strict mode, thinking in types, building for maintainability
- ▸Serverless architecture — Lambda, event-driven patterns, or equivalent distributed systems experience
- ▸Strong database fundamentals — query optimization, data modeling, understanding tradeoffs between SQL and NoSQL
- ▸API design experience — RESTful, RPC, or GraphQL at production scale
- ▸Comfort with AI tooling — you use Cursor, Copilot, or Claude daily to move faster
Nice to have
- ▸Healthcare or regulated industry experience (HIPAA, SOC 2 compliance)
- ▸Voice AI platforms (Retell, Vapi, or similar)
- ▸Telephony integration (Twilio, Telnyx)
- ▸LLM integration and prompt engineering at production scale
Why this role matters
Rivvi processes millions of patient conversations. Every API call, every workflow, every database query connects to a real person getting the care they need. The systems you build will power 40:1 leverage for healthcare teams — one care manager reaching thousands of patients through infrastructure you create.
We're at an inflection point: $500K ARR, zero customer churn, 70% margins, and demand we can't keep up with. The backend systems you build will determine how fast we can scale.
What you'll own
The API layer. Healthcare teams depend on fast, reliable APIs. You'll design the interfaces, own the performance, and evolve the architecture as we scale from thousands to millions of daily requests.
AI orchestration. Our platform coordinates voice AI agents, LLM analysis pipelines, and real-time conversation intelligence. You'll build the systems that make AI reliable and observable in production.
Data infrastructure. Millions of patient records, billions of events, real-time analytics. You'll make decisions about data modeling, query patterns, and system design that determine what's possible for the product.
Workflow automation. Every patient conversation triggers downstream workflows — tasks created, notifications sent, records updated. You'll design the event-driven systems that turn conversations into outcomes.
What we're building
Rivvi is the conversational AI infrastructure layer for healthcare. We're not a point solution — we're the platform that health systems, payers, and life sciences companies deploy to reach patients at scale.
The technical challenges are real: sub-second response times on complex AI workflows, HIPAA compliance at every layer, reliability requirements that match the seriousness of healthcare, and the kind of data complexity that comes from integrating with fragmented healthcare systems.
What success looks like
- New capabilities ship weekly with clean, well-tested interfaces
- Systems handle 10x load increases without architecture changes
- On-call is boring because systems are observable and resilient
- Other engineers love building on the primitives you create
The team
We're a small, senior team in Kendall Square. You'll work directly with the founders (Nathan, CEO, and Pranav, CTO) and ship code that reaches production the same week. No layers of management. No months-long planning cycles. Build, ship, learn, repeat.
How to apply
Apply on the careers page. Include:
- Links to systems you've built and decisions you owned
- A brief note on what draws you to healthcare infrastructure
- Anything that shows how you think about backend architecture