Fullstack Engineer

Who We Are

In a skilled nursing facility (SNF), a nurse can spend more of their shift documenting care than delivering it. Their software records what already happened ,asks for the same information over and over, and tells no one anything. If a resident's health declines, it can take days for someone to notice. 

We’re fixing that. In Prysm, data entry flows across the system. Problems escalate to the right person while there’s still time to act. And operators get real-time visibility into census, staffing, documentation, and compliance in a single command center, with the foresight to manage quality at scale. 

We’re a founding team of healthcare operators, clinicians, and engineers, backed by investors and operators deeply embedded in the industry. We have a distribution network that most startups spend years trying to build. Long-term care is a huge slice of American healthcare, and it runs on software nobody would choose today. We’re placing it, and we’re looking for the engineers who want to build that.

Role summary

You'll own features end to end across the entire stack: from the clinical APIs, data models, and reimbursement workflows that power Prysm, to the dashboards, documentation flows, and real-time views that nurses, clinicians, and operators rely on every day.

Our users are professionals doing demanding work, and the product needs to be fast, clear, and easy to trust. You'll bring strong engineering ability on both sides of the wire and enough product and design instinct to make good decisions without needing everything specified for you. You'll be hands-on building production systems, setting the bar for engineering at Prysm, and helping shape the team as it grows.

What you’ll do (core responsibilities)

• Build features end to end: design the data model, build the API, build the interface, ship it, and iterate based on feedback from real users and clinical requirements.
• Design and build Prysm’s core clinical APIs and backend services in TypeScript on AWS in Nest.js/Node.js and the React + Typescript interfaces that sit on top of them.
• Turn complex clinical workflows into clear, intuitive, responsive experiences: clinical dashboards, documentation workflows, staffing views, census management, and real-time alerts.
• Contribute to the onboarding/migration flow for facilities moving onto Prysm, the MDS billing architecture, and related reimbursement workflows so documentation is reimbursement-ready.
• Design robust data models and appropriate FHIR extensions (where valuable), and define API contracts and synchronization strategies across the stack.
• Implementations with external systems and vendors.
• Set the standard for code quality, testing, CI/CD, monitoring, and security practices (HIPAA & SOC2 readiness is important).
• Partner regularly with the CNO and facility operators: visit facilities to observe workflows, incorporate nurse feedback, and iterate quickly.
• Collaborate closely with product and design to ensure engineering solutions are operator-centric and deliver value fast.
• Mentor and help hire engineers as the team grows; set the bar for code quality, reviews, and onboarding. 

What you have

• 5+ years of full stack production engineering experience, with a track record of owning systems in production.
• Strong TypeScript experience (or similar language) or the ability to pick it up from another strongly typed language and production experience on AWS or similar Cloud Platform Solutions.
  Experience designing APIs, database schemas and backend services for complex domains and building production frontends with solid frontend architecture, state management, and performance instincts.
• Strong product orientation: you write code to define requirements, scope projects and development, and iteratively deliver.
• Excellent communicator who can work with clinical stakeholders and non-technical operators.
• Willingness to travel to facilities periodically to understand product usage in the real world.
  
   

Nice-to-have

• Experience with healthcare standards such as FHIR, MDS, or HL7, previous work integrating with EHRs, or previous experience working with industry standardized data formats.
• Experience with HIPAA, SOC2 readiness, and security/compliance engineering.
• Experience with OCR, medication mapping, or rules-based AI/automation.
• Prior experience building from scratch in a startup or working closely with operator / clinical teams in the field. 

Hiring process

• Initial screen with Talent / Hiring lead
• Technical conversation: walk through an existing engineering project you built or a live coding/architecture exercise.
• Interview with CTO (technical system design), and meetings with the core leadership team
• Final conversation with CEO/CTO.

 We aim for an efficient process and will adapt to candidate availability.

With your email please include answers to the following questions:

1. What makes you interested in joining an early stage startup/healthtech company

2. What is something impressive/difficult you have done/built.