Staff Software Engineer, Product

Tono Health; New York (NY); Hybrid; USD 180,000 - 275,000; Full time

Benefits offered by this job

Equity

Medical coverage

Unlimited PTO

Hybrid work

Founders access

Job summary

Tono Health in New York City is seeking a staff-level full stack engineer to own features end-to-end in our TypeScript monorepo. You will design database schemas, implement APIs with tRPC, and build React components for our EHR and patient portal.

You will also help accelerate the team by building AI-powered tools, iterating quickly with feature flags, and ensuring reliability in production with proper monitoring and guardrails.

Qualifications

• Staff-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.
• Experience with AI/LLM APIs and production reliability.

Responsibilities

• Own features end-to-end across a modern TypeScript monorepo: database schema design, migrations, tRPC API endpoints, and React components.
• Invest in platform to accelerate the rest of the team: building foundational agentic infra, telemetry abstractions, realtime durability primitives.
• Work on AI-powered tools like clinical note editors and model fine-tuning features.
• Maintain production reliability with structured outputs, evaluation loops, monitoring, and safe fallbacks.
• Collaborate closely with co-founders, engineers, and physicians in a fast-growing startup.

Skills

Full stack

TypeScript

Relational databases

Feature flags

Code quality

AI/LLM experience

Agent systems

Tools

PostgreSQL

Next.js

tRPC

Prisma

AWS

Job description

About Tono

Specialty care is hard to access and even harder to run. Patients often wait months, and clinics rely on fragmented tools and manual workflows.

Specialty care is hard to access and even harder to run. Patients often wait months, and clinics rely on fragmented tools and manual workflows.

Tono builds software and operations together to make specialty care faster to access and easier to deliver, starting with dermatology.

We’re building a fully autonomous specialty medicine clinic: continuous, real-time care for patients anywhere.

What makes us different is how we build. We run two clinics of our own, a national telehealth practice and an in‑person clinic in DUMBO, Brooklyn. Our engineers work side by side with our doctors and care coordinators to build (mostly) every piece of the software from scratch. The long‑term goal is for specialty clinics across the country to run on our autonomous EHR, freeing them from the administrative burden that slows care down.

Today we see patients in 33 states, covering more than 80% of the US population.

You will work closely with the co‑founders and a team of engineers and physicians (backgrounds include Amazon, Apple, and leading academic medical centers). We are backed by Village Global (backed by Mark Zuckerberg, Jeff Bezos, Michael Dell, chaired by Reid Hoffman), HOF Capital, and Oncology Ventures.

What You'll Do

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 agentic infra for others to build on top of, 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. That means structured outputs, evaluation loops, monitoring, human-in-the-loop review, and safe fallbacks. You will help turn LLM capabilities into tools clinicians actually want to use.

How We Work

• We ship quickly, with discipline: small PRs, clear ownership, and tight feedback loops.
• Small team, broad scope. Engineers regularly work across frontend, backend, data, and infrastructure.
• We ship with confidence in a regulated environment: feature flags, careful reviews, and safe migrations (including backfills). We use AI all the time but we do not vibe code our way into debt. Patients and doctors deserve better.
• We invest in maintainability. Dependency upgrades, performance work, and removing dead code are part of the roadmap.
• Observability is built-in. Logs, metrics, alerting, and error monitoring are part of the job.
• We value builders. Curiosity, good taste, and a willingness to pick up whatever the system needs goes a long way.

Stack

Frontend: Next.js, TanStack Start, React

Backend: Fastify, tRPC, Prisma, PostgreSQL

Durable Workflows: Inngest

AI: Mastra, OpenAI, Anthropic, Vertex

Infra: Cloudflare, Turborepo, Doppler, AWS, GCP

Observability: Posthog

Data: Motherduck/DuckDB, dbt, dlt, Prefect, BigQuery

What We're Looking For

• Staff-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, 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

Compensation & Benefits

Salary: 180k - 275k commensurate with experience

Equity: Meaningful equity in a high-growth, venture-backed company

Medical: Medical, dental, and vision coverage

Growth: Direct access to founders and an agile team where your impact is highly visible. We do weekly demos with leadership

PTO: Unlimited PTO to recharge when you need it

Location

New York City preferred. We are hybrid and currently spend a few days per week in our DUMBO, Brooklyn office. We will consider fully remote for the right candidate.