Senior/Staff Software Engineer (Product)

# Senior / Staff Software Engineer, (Product) **Location:** New York City (4–5 days/week in person)\ **Type:** Full-time\ **Experience:** 5+ years\ **Compensation:** $175K–$220K + meaningful early equity --- ## About us We are a full-stack dementia care company. An estimated 7.4 million Americans age 65 and older are living with Alzheimer's dementia today, and that number could reach 13.8 million by 2060 absent a medical breakthrough. Health care, long-term care, and hospice payments for this population are projected at $409 billion in 2026 — with Medicare and Medicaid covering roughly $263 billion of it and families paying about $103 billion out of pocket. That figure doesn't count the \~13 million unpaid caregivers who provided more than 19 billion hours of care in 2025, work valued at over $446 billion. Those numbers describe a system that doesn't exist. Dementia care in America is a patchwork of neurologists, primary care, social workers, home aides, adult day programs, benefits paperwork, and a spouse or adult child holding it all together with a spiral notebook. People are diagnosed an average of 3.5 years after symptoms first appear, and more than half of diagnoses in primary care come only after the disease has reached moderate or advanced stages — past the window where the newest disease-modifying therapies can help at all. We're building the company that should exist instead: clinical care, care navigation, and software as one integrated stack. We work with patients and families across the country and are rapidly expanding our footprint with hospital systems and neurology clinics. We have an exclusive partnership with Johns Hopkins, and we're a Series A company backed by top-tier investors including Y Combinator. ## Why this is the moment Three things changed at once, and the infrastructure to take advantage of them hasn't been built yet: * **Payment finally exists.** CMS launched the **GUIDE Model** (Guiding an Improved Dementia Experience) in July 2024 — a nationwide, eight-year model running through 2032 with roughly 390 participating organizations. It's one of the first CMMI models built around longitudinal, condition-specific care, and it pays per-member-per-month for exactly the things that were previously unbillable: comprehensive care plans, a dedicated care navigator, 24/7 access to the care team, and caregiver respite. * **Diagnosis is moving to the blood.** The FDA cleared the first blood-based biomarker tests for Alzheimer's — Fujirebio's Lumipulse pTau217/β-amyloid ratio, followed in October 2025 by Roche's Elecsys pTau181 for use in **primary care**. Detection is moving out of academic memory centers and into everyday clinical settings, at enormous volume. * **There's something to do after the diagnosis.** Lecanemab (2023) and donanemab (2024) both have full FDA approval, and as of May 2026 there were **158 additional Alzheimer's drugs in clinical trials, 73% of them aiming to slow progression**. Meanwhile the specialist workforce — neurologists, geriatricians, geriatric psychiatrists — is nowhere near large enough to absorb the demand, and the shortfall varies enormously by geography. Earlier detection plus real treatment options plus a payment model plus a specialist shortage equals a problem that has to be solved with software and a distributed care team. That's what we do. ## What we're looking for We want hands-on senior and staff engineers who want to take on a problem that actually matters. We are re-imagining the full stack of dementia care — the products and services families use to navigate an enormously complex disease. That spans care navigation, symptom and progression tracking, personalized medicine, clinical trial matching, benefits and caregiver support, and everything in between. This is not a role where you get handed a spec. You'll work directly with patients, their families, our clinicians, and our in-house care navigation team that supports people nationwide. You'll sit in on calls, watch navigators work, and ship the thing they needed last week. We expect engineers here to have opinions about the product and the care model, not just the implementation. We're LLM-obsessed, and not in a "we added a chatbot" way. The core bet is that AI lets a care navigation team of dozens support a population that would otherwise require thousands — synthesizing a decade of fragmented records into a usable clinical picture, surfacing progression signals before a crisis, matching patients to trials they'd never hear about otherwise, drafting the prior auth, and giving a daughter in Ohio at 2am a real answer about her father. If you're the person who keeps building agents on nights and weekends because you can't help it, this is the place to do it in production, with real stakes. ## Hard requirements * **5+ years** of professional software engineering experience * **Deep full-stack expertise** — you're genuinely strong on both ends and don't need a handoff to ship a feature * **Product-focused.** You think in terms of the user's problem and the outcome, not the ticket. You've shipped things you conceived of yourself * **Frontend development** — polished, fast, accessible interfaces used by clinicians, navigators, patients, and older adults and their families * **APIs and data backend** — schema design, service architecture, integrations with messy external systems (EHRs, labs, payers) * **Auth, security, and governance** — you've built systems handling sensitive data and you understand what HIPAA-grade actually means in practice * **LLMs and AI agents** — hands-on experience building, evaluating, and shipping LLM-powered systems, plus real creativity about applying them to push dementia care forward at scale * **Scaling large systems** — you've operated software under meaningful load and know where it breaks * **Scaling startup software** — you've been through the stage where the codebase, the team, and the customer count all triple, and you know what to build well versus what to build fast * **Top background** — top schools and/or top engineering companies * **In person in NYC, 4–5 days a week.** This is non-negotiable for us; the density of clinicians, navigators, and engineers in one room is the whole point ## Nice to have * **Healthcare experience or expertise** — EHR/FHIR integrations, claims data, value-based care, CMS models, digital health at scale, or clinical background of any kind * **DevOps and infrastructure scaling** — CI/CD, observability, cost and reliability engineering * **Data engineering** — pipelines, warehousing, and analytics infrastructure, especially over clinical and longitudinal patient data ## We are Hiring! Schedule some time [here](https://www.linkedin.com/in/vihar-desu/) Vihar (Head of Engineering) [Linkedin](https://www.linkedin.com/in/vihar-desu/) Nikhil (CEO) [Linkedin](https://www.linkedin.com/in/nikhil-s-patel/) Visa sponsorship is not available for this role.