Staff Backend Software Engineer (Elixir) - Community

You'll be joining Papa Community, a 0-to-1 venture within Papa based in San Francisco that's building virtual care for seniors. You'll have the autonomy and velocity of an early-stage startup with the advantages of a growth-stage company including Papa's deep expertise serving older adults, established health plan relationships, and reliable capital. As one of the first engineers on Community, you'll have a significant tangible impact—from architecting our platform to establishing engineering culture. Every line of code you write will have a direct, measurable outcome for the business to improve patient outcomes and drive growth.

Papa is partnering with Mission Hires, a trusted third-party platform, to help review and screen applicants for this role. Qualified candidates, please look for the individual invite from Mission Hires platform.

About the role

We are looking for our founding Staff Elixir Backend Software Engineer to build Community's technical foundation from the ground up. You'll be employee #1 on Papa Community’s engineering team, reporting directly to Papa Community's GM with dotted-line mentorship from Papa core’s engineering leadership. 

This role is unique because:

You'll own the entire technical architecture for Papa Community. Unlike joining an established engineering org where you'd work on a narrow slice of the codebase, you'll make foundational decisions about system design, technology choices, and engineering practices that will define Community for years to come.

You'll partner directly with the GM as a technical co-founder would. Your voice will shape product strategy, build vs. buy decisions, and business priorities. You won't just implement requirements—you'll help define what we build and why.

You'll leverage Papa's infrastructure while maintaining startup velocity. You can access Papa's deployment pipelines, security compliance, and DevOps support - but make decisions in days, not weeks. You'll get institutional advantages without enterprise bureaucracy.

Papa’s core business has had tremendous impact, and we are looking to bring even more results for patients with Papa Community: 

“Papa is the lynchpin that keeps me going month to month. They’re the piece of the team that allows the other pieces to happen…I can worry about finding another doctor if I have to. Finding another Papa doesn’t happen.” - Member from Tampa FL

“Papa has kind of saved me. Now I have somebody to help me go to my appointments. I’ve got somebody to help me clean my house. I’ve got somebody to talk to. It just took so much pressure off my shoulders. I’m finally feeling like myself again.” - Member from Tacoma WA

”I look forward to seeing them. They make me laugh. I make them laugh. They’ve certainly taken lonely days from me also. It works both ways for us.” - Pal from Rhode Island

What makes this role challenging:

You'll navigate complex healthcare integrations. Our platform connects EHRs, care management platforms, revenue cycle management, and patient communication tools. You'll need deep expertise in healthcare data standards (FHIR, HL7, X12) and resilient API integration patterns.

You'll balance technical perfection with shipping velocity. We're a startup - sometimes the right answer is "ship it and iterate" rather than "architect the perfect solution." You'll need judgment to know when to build for scale and when to move fast.

You'll work in a high-autonomy environment, educate stakeholders, make recommendations, and own outcomes. If you need clear requirements and detailed tickets, this isn't the role for you.

What you’ll do: 

Build the technical foundation for virtual care delivery. You'll design and implement the core platform that connects our EHR, care management systems, billing infrastructure, and patient communication tools. This means creating robust integrations, establishing data flows, and ensuring HIPAA-compliant architecture that can scale as we grow to thousands of patients.

Enable operational intelligence and automation. You'll build the data infrastructure and tooling that allows our clinical team to make informed decisions, automate care workflows, and track patient outcomes in real-time. This includes everything from patient dashboards to automated patient outreach triggers to clinical decision support.

Lead critical technical decisions. You'll evaluate build vs. buy trade-offs, recommend technology choices, and architect solutions that balance immediate needs with long-term scalability. You'll partner with the GM and Papa's engineering leadership to shape our technical roadmap and determine when to leverage vendor tools versus building custom solutions.

Establish engineering practices. As the first engineer, you'll define code standards, testing expectations, deployment processes, and technical documentation practices, leveraging best practices from the Papa core engineering team. 

Own system reliability and performance. You'll be responsible for production stability, monitoring, and continuous improvement of our platform. This means building resilient systems for healthcare-critical workflows where reliability isn't optional - claim submissions, patient data accuracy, and care coordination all need to work consistently.

Skills we look for: 

Product mindset - You think like a founder, balancing technical excellence with business outcomes, revenue, and patient impact. You see gaps as opportunities and help define what we build, not just how.

Strategic technical leadership - You lead large, complex projects with clear business impact. You influence senior leaders on engineering strategy and make compelling recommendations on build vs. buy decisions, strategic technical investments, and any relevant engineering decisions.

Deep backend expertise - Expert-level proficiency in Elixir with deep knowledge of distributed systems, API design, and building scalable architectures that solve problems long-term.

System design and reliability - You build resilient, well-tested systems with proper monitoring, rollout practices, and production stability for healthcare-critical workloads.

High autonomy and ownership - You thrive in ambiguous environments, educate non-technical stakeholders, and own outcomes without needing detailed requirements or constant direction.

Startup adaptability - You're highly communicative across operational and clinical teams, move fast when needed, and understand when to ship quickly versus architect for scale.

Continuous improvement mindset - You proactively identify areas for improvement in systems and processes without being asked, and drive initiatives to address them.

Minimum qualifications:

• 10+ years of software development experience
• Expert-level proficiency in Elixir
• Experience building and shipping high quality work and achieving high reliability
• Experience improving quality through thoughtful code reviews, appropriate testing, proper rollout, and monitoring
• Passionate about improving healthcare access and outcomes

Preferred qualifications:

• Experience with healthcare technology including data standards (FHIR, HL7, X12), EHR/vendor integrations, HIPAA-compliant systems for protected health information, and healthcare-specific APIs (clearinghouses, billing platforms)
• Experience with Phoenix LiveView

Location

• Hybrid with 2-3 days per week in-office in San Francisco, CA

Compensation & Benefits:

• Target salary range of $200,000 to $230,000 
• Equity
• Medical, dental and vision insurance coverage
• Health Savings Account (HSA) & Flexible Spending Account (FSA)
• 401(k) plan with a match up to 4%
• Flexible PTO & 11 company holidays
• Parental leave and caregiver leave 

Actual compensation will be determined based on a variety of factors, including but not limited to candidate experience, location, education, certifications, and skill set. In addition to base salary, our total compensation package includes equity, comprehensive health benefits (medical, dental, vision), generous paid time off, and additional wellness and professional development perks.

Not sure if you meet every requirement? Research shows that women and people from historically underrepresented communities often hesitate to apply for roles unless they meet every qualification compared to other similarly-qualified candidates. At Papa Community, we are committed to fostering a workplace where everyone feels valued, empowered, and supported. If this role excites you, we encourage you to apply.

About Papa's culture: 

Papa’s culture is people first. While we have an incredible team of hard-working Papa people, at the end of the day, our company is really about community – and we celebrate that among our employees. We encourage everyone to bring their whole authentic selves to work. To be transparent. To be non-hierarchical. And, above all, to be a really good person.

We see ourselves as a place where every Papa employee feels they belong, a place where careers flourish, a place that brings back purpose and joy to work, a culture where visionaries/entrepreneurs are developed.

Papa is an equal opportunity employer. We proudly support the ParityPledge® for gender and racial parity at the highest levels of business.