Staff Backend Software Engineer - San Francisco, California

MissionHires; San Francisco (CA); Hybrid; USD 200,000 - 230,000; Full time

Benefits offered by this job

Equity

Medical, dental, and vision insurance

Health Savings Account (HSA)

Flexible Spending Account (FSA)

401(k) plan with up to 4% match

Flexible PTO & 11 company holidays

Parental leave and caregiver leave

Job summary

MissionHires is seeking a Staff Elixir Backend Software Engineer in San Francisco. In this pivotal role, you will establish the technical architecture for virtual care delivery while navigating complex healthcare integrations. You'll be the first engineer in the team, leveraging your expert-level Elixir skills to create scalable and resilient systems.

Join us in enhancing healthcare access and outcomes while enjoying a hybrid work environment. A competitive salary range of $200,000 to $230,000 is provided, along with comprehensive benefits.

Qualifications

• 10+ years of experience in software development.
• Expert-level proficiency in Elixir.
• Experience with EHR/vendor integrations and HIPAA-compliance.

Responsibilities

• Build the technical foundation for virtual care delivery.
• Enable operational intelligence and automation.
• Lead critical technical decisions.
• Establish engineering practices.
• Own system reliability and performance.

Skills

Product mindset

Strategic technical leadership

Deep backend expertise (Elixir)

System design and reliability

High autonomy and ownership

Startup adaptability

Continuous improvement mindset

Education

10+ years of software development experience

Expert-level proficiency in Elixir

Tools

EHR integrations

Phoenix LiveView

Job description

You are joining Papa Community, a 0-to-1 venture within Papa based in San Francisco that is building virtual care for seniors. As one of the first engineers on Community, you will have the autonomy and velocity of an early‑stage startup with the advantages of a growth‑stage company, including Papa’s deep expertise serving older adults, established health plan relationships, and reliable capital.

About the role

We are looking for a founding Staff Elixir Backend Software Engineer to build Community’s technical foundation from the ground up. You will be employee #1 on Papa Community’s engineering team, reporting directly to Papa Community’s GM while receiving mentorship from Papa core’s engineering leadership.

This role is unique because

You will own the entire technical architecture for Papa Community, making foundational decisions about system design, technology choices, and engineering practices that will define the platform for years to come.

What makes this role challenging

• You will navigate complex healthcare integrations connecting EHRs, care management platforms, revenue cycle management, and patient communication tools, requiring deep expertise in FHIR, HL7, X12 and resilient API integration patterns.
• You will balance technical perfection with rapid shipping in a startup environment, using judgment to decide when to build for scale and when to ship quickly.
• You will work in a high‑autonomy setting, making recommendations to stakeholders and owning outcomes without the need for detailed requirements.

What you’ll do

• Build the technical foundation for virtual care delivery. Design and implement the core platform that connects EHRs, care management systems, billing infrastructure, and patient communication tools, ensuring HIPAA‑compliant, scalable architecture.
• Enable operational intelligence and automation. Build data infrastructure and tooling that allow the clinical team to make informed decisions, automate care workflows, and track patient outcomes in real time.
• Lead critical technical decisions. Evaluate build vs. buy trade‑offs, recommend technology choices, and architect solutions that balance immediate needs with long‑term scalability.
• Establish engineering practices. Define code standards, testing expectations, deployment processes, and technical documentation practices, leveraging best practices from Papa core engineering.
• Own system reliability and performance. Ensure production stability, monitoring, and continuous improvement for healthcare‑critical workflows.

Skills we look for

• Product mindset. Think like a founder, balancing technical excellence with business outcomes and patient impact.
• Strategic technical leadership. Lead large, complex projects with clear business impact and influence senior leaders on engineering strategy.
• Deep backend expertise. Expert‑level proficiency in Elixir with knowledge of distributed systems, API design, and scalable architectures.
• System design and reliability. Build resilient, well‑tested systems with proper monitoring, rollout practices, and production stability for healthcare‑critical workloads.
• High autonomy and ownership. Thrive in ambiguous environments, educate non‑technical stakeholders, and own outcomes without detailed direction.
• Startup adaptability. Communicate across operational and clinical teams, ship quickly when needed, and balance scaling considerations.
• Continuous improvement mindset. Proactively identify improvement areas in systems and processes and drive initiatives to address them.

Minimum qualifications

• 10+ years of software development experience
• Expert‑level proficiency in Elixir
• Experience building and shipping high‑quality, highly reliable work
• Experience improving quality through thoughtful code reviews, comprehensive testing, appropriate rollout, and monitoring
• Passionate about improving healthcare access and outcomes

Preferred qualifications

• Experience with healthcare technology, including data standards (FHIR, HL7, X12), EHR/vendor integrations, HIPAA‑compliant systems, and healthcare‑specific APIs
• Experience with Phoenix LiveView

Location

• Hybrid with 2‑3 days per week in‑office in San Francisco, CA

Compensation & Benefits

• Target salary range of $200,000 to $230,000
• Equity
• Medical, dental and vision insurance coverage
• Health Savings Account (HSA) & Flexible Spending Account (FSA)
• 401(k) plan with a match up to 4%
• Flexible PTO & 11 company holidays
• Parental leave and caregiver leave

Actual compensation will be determined based on a variety of factors, including candidate experience, location, education, certifications, and skill set. In addition to base salary, the total compensation package includes equity, comprehensive health benefits, generous paid time off, and additional wellness and professional development perks.

About Papa’s culture

Papa’s culture is people‑first. At the end of the day, the company is about community. We encourage everyone to bring their authentic selves to work, be transparent, non‑hierarchical, and to be a good person. We aim for a place where every employee feels they belong, careers flourish, and purpose and joy are found at work.

Papa is an equal opportunity employer. We proudly support the ParityPledge for gender and racial parity at the highest levels of business.