Founding Backend Engineer

Rivvi AI, Inc; Cambridge (MA); On-site; USD 120,000 - 150,000; Full time

Benefits offered by this job

Founding equity (0.5–2%+)

Comprehensive health, dental, and vision

Equipment budget and professional development stipend

Job summary

A healthcare AI company in Cambridge, MA seeks a Founding Backend Engineer to architect and build the backend for its patient engagement platform. Responsibilities include developing the API layer and designing AI orchestration systems. Candidates should have over 5 years of backend experience, strong TypeScript skills, and a background in serverless architectures. This full-time role offers a competitive salary range and equity ownership, emphasizing direct collaboration with company founders.

Qualifications

• 5+ years backend engineering or 3+ years with MS in CS.
• TypeScript expertise thinking in types.
• Experience with serverless architecture or equivalent systems.

Responsibilities

• Own the backend and architecture for Rivvi's platform.
• Design AI orchestration that coordinates voice agents.
• Build event-driven systems converting conversations into outcomes.

Skills

TypeScript expertise with strict mode

Serverless architecture experience

Strong database fundamentals

API design experience

Comfort with AI tooling

Education

5+ years backend engineering or 3+ years with MS in CS

Tools

Lambda

Twilio

Cursor

Job description

Overview

CTO @ Rivvi.ai | Building Intelligent Patient Engagement Systems | AI Infrastructure for Healthcare | Ex-CVS Health

Company Description

Rivvi AI, Inc. builds conversational AI infrastructure for healthcare. The platform that health systems, payers, and life sciences companies deploy to reach patients at scale. Rivvi powers scalable patient outreach for medication adherence, care gap closures, chronic care management, and clinical trials. The platform manages millions of patient interactions across voice and messaging without requiring EMR integrations, enabling healthcare teams to deploy in days, not months. Our AI is talking to real patients right now. Rivvi is headquartered in Cambridge, MA and was founded in 2024.

Role Description

This is a full-time on-site role based in Cambridge, MA for a Founding Backend Engineer. You will own the backend. Architect systems, build them, own the outcomes. You\'ll build the infrastructure layer powering millions of patient conversations. The API layer healthcare teams depend on. The AI orchestration that coordinates voice agents and LLM pipelines. The event-driven systems that turn conversations into outcomes. Your architectural decisions will determine how fast we scale. This is founding engineer territory, not ticket-taking. You\'ll work directly with the founders and ship code that reaches production the same week. No layers of management. No months-long planning cycles. Build, ship, learn, repeat.

Responsibilities

• Own the backend and architecture for Rivvi\'s platform.
• Architect, build, and own infrastructure powering millions of patient conversations.
• Develop the API layer used by healthcare teams.
• Design AI orchestration that coordinates voice agents and LLM pipelines.
• Build event-driven systems that convert conversations into outcomes.
• Make architectural decisions to enable rapid scaling and production readiness.
• Collaborate directly with founders; ship production code within weeks.

Qualifications

• 5+ years backend engineering (or 3+ years with MS in CS)
• TypeScript expertise with strict mode, thinking in types, building for maintainability
• Serverless architecture experience with Lambda, event-driven patterns, or equivalent distributed systems
• Strong database fundamentals including query optimization, data modeling, and understanding tradeoffs between SQL and NoSQL
• API design experience with RESTful, RPC, or GraphQL at production scale
• Comfort with AI tooling. You use Cursor, Copilot, or Claude daily to move faster.
• Healthcare or regulated industry experience is a plus
• Voice AI platforms like Retell or Vapi is a plus
• Telephony integration with Twilio or Telnyx is a plus
• LLM integration and prompt engineering at production scale is a plus

Compensation

• Founding equity (0.5–2%+) with real ownership
• Salary $120K–$150K based on experience
• Comprehensive health, dental, and vision
• Equipment budget and professional development stipend
• Direct collaboration with founders on product and architecture decisions

Seniority level

• Mid-Senior level

Employment type

• Full-time

Job function

• Engineering and Information Technology

Industries

• Hospitals and Health Care