Senior Software Engineer Backend (Vancouver) at Flagler Health

Flagler Health is building the clinical operating system for modern musculoskeletal care.

We partner with MSK provider groups and specialty clinics to help them grow, operate more efficiently, and deliver better longitudinal care across patient acquisition, clinical workflows, and ongoing patient engagement. Our platform sits at the intersection of care delivery and clinic operations, helping providers capture more value across the full patient lifecycle.

We’ve recently raised our Series B and are entering our next phase of growth.

The Role:

You will own large parts of our backend, from design through production: the systems you build are yours to shape, operate, and evolve.

We expect you to think through the design of a modern stack and defend the decisions: what fails gracefully, what has to be correct every time, what gets written down, and what your teammates need to know to work on it without you. We use AI coding agents heavily and expect the same rigor applied to what they produce.

We are looking for engineers who have carried a highly available system in production and let that experience shape how they build.

What You’ll Do:

• Design, build, and maintain backend services, AI agents, temporal workflows and other parts of the application layer

• Work on real-time web applications for audio and SMS communications with users (patients)

• Implement and operate fault-tolerant, long-running workflows for asynchronous and background processing

• Collaborate with frontend, product, and infrastructure teams to deliver reliable, compliant systems

Required Qualifications:

• roven experience building highly available backend applications in a

  regulated environment (e.g., healthcare, finance, compliance-driven SaaS)

  ● BS in Computer Science or related field

  ● Proficiency in TypeScript and/or Python for backend service development

  ● Experience interacting with backend APIs built using Node.js, Express,

  MongoDB, Twilio or similar frameworks

  ● Experience with Temporal or similar distributed workflow orchestration

  systems (e.g., Cadence, AWS Step Functions, Conductor)

  ● Solid understanding of distributed systems fundamentals, including retries,

  idempotency, and failure handling

• Proven experience building highly available backend applications in a regulated environment (e.g., healthcare, finance, compliance-driven SaaS)

• Proficiency in TypeScript and/or Python for backend service development

• Experience interacting with backend APIs built using Node.js, Express, Mongoose, Twilio or similar frameworks

• Experience with Temporal or similar distributed workflow orchestration systems (e.g., Cadence, AWS Step Functions, Conductor)

• Solid understanding of distributed systems fundamentals, including retries, idempotency, and failure handling

Preferred Qualifications:

• Experience in healthcare technology or SaaS platforms at a medium-sized startup

• Familiarity with HL7, FHIR, or EHR integrations

• Experience with cloud platforms such as AWS, Azure, or GCP

• Hands-on experience with CI/CD pipelines, infrastructure automation, and version control systems (e.g., Git)

• Experience working in a monorepo setup (e.g., Turborepo, Nx)

• Experience with distributed data or batch processing frameworks (e.g., Apache Spark, Databricks, or similar)

• Exposure to DevOps practices, including containerization, observability, and deployment automation

Work Environment:

• Distributed remote team with hybrid offices in NYC and Vancouver.

• Hybrid. Regular and consistent on-site presence is required for this position.

• We have video on for our weekly team syncs and pair-coding/tech discussions. Camera is required to be on during meetings.

Our Values:

This is what you can expect of your teammates at Flagler:

• Owner: We own our work like founders. We don't wait to be asked, and we pick up the problem nobody else has.

• Builder: We like making things from scratch. We don't need a playbook to start, and we'd rather ship a rough first version than wait on a perfect spec.

• Fast: We make quick decisions. We favor progress and respect process.

• Transparent: We communicate directly. We value merit and honesty, and we challenge assumptions, including our own.

• Curious: We explore new approaches and ask "why" often.