Senior Full-Stack Engineer — Healthcare AI, Hybrid, Equity

alt Inc; New York (NY); Hybrid; USD 160,000 - 275,000; Full time

Benefits offered by this job

Equity

Medical insurance

Unlimited PTO

Direct access to founders

Job summary

Tono in New York City seeks a senior full-stack engineer to own features end-to-end in a modern TypeScript monorepo. You’ll design schemas, implement Prisma migrations, and build tRPC endpoints and React components for our EHR and patient portal.

You’ll help expand AI-driven workflows, ensure reliability with monitoring and human-in-the-loop review, and collaborate with doctors and engineers to ship rapidly in a regulated healthcare environment.

Qualifications

• Senior level full stack experience building and operating production systems.
• Strong TypeScript skills across frontend and backend.
• Expert relational database fundamentals: schema design, migrations, query performance
• Comfort shipping iteratively: feature flags, instrumentation, and tight feedback loops
• You care about code quality because you take pride in your craft
• You can drive outcomes. You have the ability to take an ambiguous problem, break it down into workstreams, manage and execute
• You have worked on agent systems. Designing evals, data-labeling techniques, self-improving agent loops, and LoRA fine tuning
• Nice to have (not required): experience in startups, healthcare, regulated industries, complex domain modeling, or multi-tenant systems
• You have built with AI/LLM APIs and understand what it takes to make them reliable in production.

Responsibilities

• Own features end-to-end across a modern TypeScript monorepo: database schema design, Prisma migrations, tRPC API endpoints, and React components in our EHR and patient portal.
• Invest in platform to accelerate the rest of the team: building foundational infra, telemetry abstractions, realtime durability primitives, etc.
• On any given week you might be building an AI-powered clinical note editor, refactoring a Stripe billing flow, LoRA post-training on an open source model for clinical workflows, or digging into data to see where patients are dropping off in the intake funnel.
• We build AI features that have to be reliable in production with structured outputs, evaluation loops, monitoring, human-in-the-loop review, and safe fallbacks.

Skills

Senior level

TypeScript

Relational DB

Feature flags

Code quality

Outcome driven

Agent systems

AI/LLM APIs

Tools

Fastify

tRPC

Prisma

PostgreSQL

Job description

Tono in New York City seeks a senior full-stack engineer to own features end-to-end in a modern TypeScript monorepo. You’ll design schemas, implement Prisma migrations, and build tRPC endpoints and React components for our EHR and patient portal.

You’ll help expand AI-driven workflows, ensure reliability with monitoring and human-in-the-loop review, and collaborate with doctors and engineers to ship rapidly in a regulated healthcare environment.