Founding Software Engineer, Full-Stack (HealthTech / AI) - A136

Work Arrangement: Remote or In-Person (New York City, NY)
Job Type: Independent Contractor, Full-time
Work Schedule: Monday to Friday | 40 hours

Locations:

• United States (NYC preferred)
• Open to remote candidates with overlapping U.S. hours

Pearl works with the top 1% of candidates from around the world and connects them with the best startups in the US and EU. Our clients have raised over $5B in aggregate and are backed by companies like OpenAI, a16z, and Founders Fund. They’re looking for the sharpest, hungriest candidates who they can consistently promote and work with over many years. Candidates we’ve hired have been flown out to the US and EU to work with their clients, and even promoted to roles that match folks onshore in the US.

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Why Work with Us?
At Pearl, we’re not just another recruiting firm—we connect you with exceptional opportunities to work alongside visionary US and EU founders. Our focus is on placing you in roles where you can grow, be challenged, and build long-term, meaningful careers.

We’re seeking a Founding Full-Stack Software Engineer to join a fast-growing AI-driven HealthTech startup that’s redefining pharmacy automation. Their agentic AI platform is already deployed across multiple U.S. pharmacies, streamlining workflows and improving patient access and care.

As a Founding Engineer, you’ll collaborate directly with the founders to design, build, and scale the company’s AI infrastructure. You’ll work across the stack—from backend systems and LLM integrations to frontend product delivery—owning projects that make real-world clinical impact. This role is perfect for an engineer who thrives in early-stage, high-velocity environments and wants to help shape the future of healthcare technology.

You’ll be instrumental in building the technical foundation of a category-defining HealthTech startup. From architecting AI workflows that optimize pharmacy operations to ensuring scalable, HIPAA-compliant systems, your work will directly enhance patient outcomes and redefine what’s possible in digital healthcare.

AI System Development & Integration – 30%

• Design and implement AI-powered workflows for pharmacy operations.
• Build and refine LLMs, agentic systems, and integrations that power patient and staff interactions.
• Use prompt engineering and experimentation to optimize performance and contextual accuracy.

Backend Engineering & Infrastructure – 30%

• Architect and scale backend systems using Python, TypeScript, and Postgres.
• Develop APIs ensuring performance, security, and reliability.
• Maintain CI/CD pipelines for safe, rapid deployment.
• Ensure HIPAA-compliant infrastructure and data integrity.

Frontend & Product Collaboration – 20%

• Build modern, responsive UIs with frameworks like React.
• Partner with product and design teams to translate ideas into high-performing user experiences.
• Establish continuous feedback loops with customers to refine product direction.

Scalability & System Reliability – 10%

• Diagnose and optimize system bottlenecks to improve reliability and performance.
• Implement monitoring and testing frameworks to ensure uptime and resilience.
• Support integrations across both cloud and on-prem environments.

Strategic & Cross-Functional Collaboration – 10%

• Contribute to the long-term technical roadmap and architecture decisions.
• Mentor new engineers as the team scales.
• Work directly with leadership to translate business goals into technical deliverables.

Requirements

Must-Have (Required):

• 4 years of full-time software engineering experience (excluding internships).
• Strong backend development experience with Python, TypeScript, Postgres, and AWS.
• Hands-on experience with LLMs, prompt engineering, or voice AI systems (personal or production).
• Proven success designing and scaling systems for production environments.
• Prior experience in startups or early-stage engineering teams.
• Strong communication and collaboration skills across technical and non-technical teams.
• High ownership mindset and bias toward fast, iterative shipping.

Nice-to-Have (Preferred):

• Prior experience as a founding engineer or technical lead in a startup.
• Background in healthtech, pharmacy tech, or clinical automation.
• Familiarity with AI engineering tools such as Copilot, Cursor, or Replit Ghostwriter.

Required:

• Languages: Python, JavaScript, TypeScript
• Backend: FastAPI, Flask, Node.js
• Frontend: React or modern JS frameworks
• Database: PostgreSQL
• Infrastructure: AWS (Lambda, EC2, S3), Docker
• AI Stack: OpenAI APIs, LangChain, vector databases
• Version Control & CI/CD: GitHub, CircleCI

Preferred:

• HIPAA-compliant frameworks
• Data encryption and security libraries
• AI-powered productivity tools

Benefits

• Competitive Salary: Based on experience and skills
• Remote Work: Fully remote—work from anywhere
• Performance Bonus: Based on data accuracy, reporting timeliness, and overall sales efficiency
• Team Incentives: Recognition for maintaining 100% CRM hygiene and on-time reporting
• Health Coverage for PH-based talents: HMO coverage after 3 months for full-time employees
• Direct Mentorship: Guidance from international industry experts
• Learning & Development: Ongoing access to resources for professional growth
• Global Networking: Connect with professionals worldwide
• Work-Life Balance: Flexible hours that support a healthy balance

1. Application
2. Screening
3. Initial Interview
4. Skills Assessment
5. Final Interview
6. Job Offer
7. Onboarding

If this role aligns with your skills and goals, apply now to take the next step in your journey with Pearl.