Full Stack Engineer — Healthcare SaaS (Contract or Full Time)

The Role

We are hiring a senior full stack engineer to build the COUNSELMEDS production platform from a fully designed and functional interactive demo. You will work directly with the founder, own all architectural decisions across our React, Node.js, PostgreSQL, and AWS stack, and ship a working production platform in 45 to 60 days.

We need someone senior enough to move fast, make decisions independently, and deliver without hand-holding. A fully designed interactive demo is complete and ready for build. Full technical specifications, data models, and integration documentation are provided to shortlisted candidates under NDA.

What You Will Build

You will build a HIPAA-compliant clinical operations platform for licensed pharmacists managing Medicaid member caseloads. The platform includes:

• Pharmacist clinical workflow dashboard with telehealth call integration
• AI-powered clinical documentation generation from call transcripts
• Automated patient SMS check-in engine with biometric response parsing
• Medication adherence tracking across large member populations
• Billing readiness dashboard for clinical claims management
• HIPAA-compliant data infrastructure on AWS with full audit logging
• Role-based access control for multiple user types

Required Technical Skills

Must Have:

• 7+ years production experience with React and TypeScript
• 7+ years production experience with Node.js and Express or Next.js
• Expert PostgreSQL skills including data modeling and query optimization at scale
• Deep AWS production experience with EC2, RDS, S3, Lambda, CloudWatch, and KMS
• Documented experience building HIPAA-compliant applications
• Production Twilio Voice and SMS integration experience
• Production LLM API integration experience with Anthropic Claude, OpenAI, or equivalent
• Auth0 or equivalent RBAC implementation in production
• Experience building systems handling 10,000 or more concurrent user records
• Ability to deliver a production MVP in 60 days independently

Nice to Have:

• Deepgram or similar real-time transcription API experience
• Prior healthcare SaaS or digital health platform experience
• Familiarity with HEDIS quality measures or Medicaid billing
• Prior first engineer or sole engineer experience at an early stage startup
• Prior CTO or technical lead experience
• Located in or willing to travel to St. Louis, Missouri periodically

Interview Process

• Initial 30-minute intro call with founder
• NDA execution and full technical brief shared
• Technical screening — 45-minute live architecture discussion
• Paid take home project
• Final 60-minute interview with founder
• Decision within 48 hours of final interview

Pay: $75.00 - $150.00 per hour

Application Question(s):

• Do you have 7 or more years of production experience with React and TypeScript?
• Do you have 7 or more years of production experience with Node.js or Next.js?
• Have you integrated Twilio Voice or Twilio SMS in a production application?
• Do you have production experience with AWS including RDS, S3, Lambda, and KMS?
• Describe a HIPAA-compliant healthcare application you built. What PHI was involved and how did you handle encryption and audit logging?

Work Location: Hybrid remote in St. Louis, MO 63112