About Ramona Health:
Ramona Health is building a new kind of Medicare Advantage plan designed from the ground up to actually improve senior health outcomes, not just manage sickness. We're integrating a proprietary AI coach with a network of high-touch primary care partners to create a proactive, personalized member experience focused on reversing chronic disease trends and reducing downstream costs. We are early-stage, ambitious, and aiming to launch our first MA plan in CY 2027. This is not for the faint of heart.
The Challenge & Opportunity:
We are not just building another health plan; we are building the AI-first, autonomous insurer of the future. The technical challenge is immense and fascinating: architect and build the entire nervous system of this company from scratch. This means designing a hybrid architecture that balances a deterministic, auditable core for insurance operations with a flexible, agentic edge for our AI Coach. You won't be maintaining legacy code; you will be making the foundational decisions that define our technical DNA and competitive advantage for the next decade.
Our Tech Philosophy & Stack:
We believe in using the right tool for the job, favoring pragmatic choices that let a small team move fast. We aim to build a calm, focused engineering culture. You will be instrumental in shaping and evolving this stack:
- Languages: TypeScript and Python are our primary languages.
- Backend: We value speed and strong typing. We're building services with Django & Node and using PostgreSQL for our primary data store.
- Orchestration: Durable, auditable workflows are critical for our operations. We are building our core deterministic logic on Temporal.
- AI / LLM: Our AI coach is a core product. We build with models from a range of open source and proprietary providers, leverage RAG patterns, and to date have hand coded orchestration but are open to using frameworks like LangChain.
- Health Data: We are building on a modern, FHIR-native core, using platforms like Medplum to manage clinical data and ensure interoperability.
- Infrastructure: We deploy on modern, serverless-friendly platforms to stay lean and focus on building product, not managing servers.
Responsibilities
As our Founding Engineer, you are the technical owner of the Ramona Health platform. This is a leadership role for a builder who wants to code >70% of the time. You will report directly to the CEO and be his primary technical partner.
- Own the Platform from Zero to One: You will lead the hands-on development of our entire platform. Your first mission is to architect and build our 'New Member Onboarding' flow—a service that integrates our AI coach, our core database, and our Temporal-based workflow engine.
- Lead AI Product Development: You will take over our v1 AI Coach—already in active pilots—and steer its evolution. This means owning the roadmap from improving our evaluation frameworks and agentic capabilities to scaling the infrastructure for multi-modal (SMS/voice) engagement.
- Define the Engineering Culture: As the founding engineer, you will define what it means to be an engineer at Ramona. You will establish our technical hiring bar, our code review standards, our CI/CD practices, and our philosophy on addressing technical debt.
- Be the Technical Partner to Product: You will work in a tight loop with our CEO, who serves as the Head of Product. He will be responsible for the "what" and the "why"; you will be responsible for the "how," translating user needs and business requirements into robust, scalable technical solutions.
- Architect for Security & Compliance: You will own the technical implementation of our security and compliance posture. You will make architectural decisions that ensure HIPAA compliance is a foundational, non-negotiable part of our platform.
- Drive All Key Technical Decisions: You will lead all "build vs. buy" analyses, select and manage our vendors, and have final say on the architecture and technologies we use to build a lean, efficient, and powerful system.
Requirements
Who We're Looking For (The Non-Negotiables):
- A True Senior Builder: You have 5+ years of experience and a portfolio of complex, scalable backend systems you have personally built and shipped. You love the craft of engineering and are highly proficient with modern stacks like Python/TypeScript, Django/Node, and PostgreSQL.
- Architectural Pragmatism & Vision: You can reason about high-level system design and its trade-offs. You know when to build a quick MVP and when to invest in a scalable foundation. You have opinions but are not dogmatic.
- Deep, Hands-on AI/LLM Experience: You have built and deployed production or advanced prototype applications using LLMs. You can speak fluently about the trade-offs between RAG and fine-tuning, the nuances of prompt engineering, and the challenges of evaluating agentic systems.
- Product-Minded & User-Focused: You are driven to understand the "why" behind what you're building. You care deeply about the end-user experience and can think through problems from the perspective of our members, our physician partners, and our internal operations team.
- Extreme Ownership & Startup Mentality: You are energized by ambiguity and the opportunity to build from a blank slate. You can take a high-level goal, decompose it into concrete steps, and drive it to completion with minimal supervision.
- Bonus Points (The Icing on the Cake): Deep experience with durable execution frameworks (Temporal is a huge plus). Experience in a regulated industry like health tech (HIPAA, FHIR) or fintech. Experience building and scaling event-driven architectures. A passion for improving the US healthcare system.
What We Offer:
- High Impact & Equity: This is a ground-floor opportunity with significant ownership in what we build, vesting over time and with potential upside tied to key company milestones (like successful plan launch).
- Build From Scratch: The chance to design and implement an MA plan the right way, without legacy baggage.
- Mission-Driven Team: Work directly with a CEO and CMO (Chief Medical Officer) laser-focused on improving health outcomes.
- The Startup Reality: Intense pace, high stakes, ambiguity, and the potential for massive reward.
- Competitive Salary (but the real upside is the equity).