Senior Software Engineer

About Skylight Health Skylight Health is transforming specialty care by connecting patients, clinicians, and payors through a value-based care platform. We are building the operating system for specialty care orchestration: helping patients navigate complex healthcare needs, supporting providers with better coordination and insights, and partnering with payors to improve outcomes and create measurable value. We're backed by leading healthcare investors including Valtruis and a16z, and we're a series A company with a growing team dedicated to solving the hardest problems in specialty care delivery. Our work is guided by our company values: Patient Committed: We are dedicated to improving patient outcomes and experiences, recognizing that the interaction between patient and clinician is the most important moment in healthcare. We let this commitment guide our work even when it requires difficult tradeoffs. Trusted Orchestration: We become the partner of choice by consistently helping patients, providers, and payers succeed, building meaningful relationships founded on mutual trust. We are a reliable connector that strengthens collaboration across the specialty care ecosystem. Disproportionate Impact: We pursue breakthrough outcomes that far exceed expectations, refusing to let artificial barriers limit our ambitions. We focus on solutions that create meaningful, measurable change in healthcare delivery and patient outcomes. Disciplined Agility: We make informed decisions quickly and execute with conviction, while remaining open to new information that may require us to adjust course. We balance speed with thoughtfulness so we can adapt without losing momentum. Own the Solution: We take full responsibility for our commitments and outcomes, following through on what we promise and addressing challenges head-on. We focus on solving problems. Authenticity: We encourage everyone to bring their true selves to work and communicate honestly and transparently. We create an environment where all people feel safe to share ideas and challenge assumptions. About the Role You’ll own core development on our referral platform that enables our team to define and orchestrate agentic healthcare referral workflows at scale. This role is on a small, high-agency team where you’ll work directly with the CTO and two other engineers on core platform capabilities. In this role, you will build workflow orchestration engines, agent coordination logic, and backend/frontend infrastructure that lets our users define, test, and deploy multi-step referral workflows. You’ll work closely with the CTO, product, and healthcare stakeholders to translate clinical requirements into reliable, scalable agentic systems. This is a strong fit for someone who thrives with autonomy, enjoys solving hard distributed systems problems, brings hands-on technical judgment to complex tradeoffs, and is motivated by direct healthcare impact. What You’ll Do Agentic referral workflow development : Build and maintain healthcare referral workflow definitions, agent coordination logic, and integrations using browser agents within the platform. Continue to buildout our outbound agent calls and text conversations with patients and clinicians. Incorporate internally developed intelligent routing and multispecialty intelligence into the referral engine. Web app infrastructure : Develop backend APIs (Node.js, REST/GraphQL), web UI components (React or similar), and data models that create seamless human-on-the-loop and in-the-loop experiences for users. Healthcare claims data integration & analytics : Use healthcare claims data from CMS and other sources to inform workflow behavior, build new data pipelines into the app, and maintain existing analyses that power workflow decisions. Technical debugging & optimization : Troubleshoot workflow failures, optimize data retrieval from healthcare sources, and improve platform reliability and performance at scale. Cross-functional collaboration : Work with data science, engineering, product, and clinical teams to understand healthcare referral workflows and translate requirements into technical solutions. What We’re Looking For 5 years of software development in production environments, with demonstrated ability to own systems end-to-end and strong system design judgment. You have used agents in a production code base and are familiar with SDD for maintaining and extending the code base. Hands-on experience with agentic or AI systems — you’ve built, deployed, or maintained agents (LLM-based, workflow orchestration, or similar). You understand agent state management, failure modes, and multi-step coordination. JavaScript/TypeScript mastery — with an agent you ship clean, maintainable TypeScript/JavaScript across backend (Node.js, APIs), frontend (React or similar), and multiple contexts. You’re comfortable with modern web frameworks and tooling. SQL & data engineering competency — you can understand complex queries, design data schemas, and build/iterate on ETL and data processing pipelines. Comfort with PySpark for distributed workloads is valued. Nice to Have Experience in a HIPAA compliant environment Experience with large healthcare datasets GCP (ex. Cloud Build, Cloud Run, Artifact Registry) or Databricks experience PySpark for distributed data processing Exposure to healthcare referral, prior authorization, or care coordination workflows dbt familiarity for data transformation What Success Looks Like In your first 30 days, you will: Onboard on the platform codebase, understand the current referral workflow architecture, and get familiar with CMS healthcare claims data integration patterns. Build relationships with the CTO, engineering team, and product stakeholders; understand the current customer use cases and roadmap. Ship 3 bug fixes or feature refinements to the workflow engine. In your first 60 days, you will: Own and ship a meaningful feature or infrastructure improvement (ex. new workflow step type, improved state management, new API endpoint) that directly benefits customers. Contribute to CMS healthcare claims data pipeline improvements or new analyses that feed workflow decisions. Establish clear code ownership patterns and begin mentoring on technical decisions across your area. In your first 90 days, you will: Deliver a measurable product or infrastructure outcome (ex. new workflow capability, performance improvement, new customer workflow type) that improves customer adoption or referral success rates. Own a cross-functional initiative (ex. new referral workflow type, integration improvement) end-to-end with minimal oversight. Contribute to product roadmap planning and help shape the platform’s technical direction. How We Work We move quickly, but thoughtfully. We value clear ownership, high-trust collaboration, and direct communication. We work across product, clinical, operations, data, and partnerships to solve complex healthcare problems. We expect teammates to bring strong judgment, curiosity, and a willingness to operate in ambiguity. We use technology responsibly and thoughtfully, especially when working with sensitive healthcare information. Benefits & Perks Comprehensive health, dental, and vision coverage Unlimited PTO with flexibility for work-life balance Remote-first with occasional (2-3 times per year) in-person collaboration Early-stage equity (stock options aligned with early employees) Learning and development support; budget for conferences, courses, and tools Collaborative, early-stage team environment with direct access to leadership Equal Opportunity Skylight Health is an equal opportunity employer. We welcome candidates from all backgrounds and are committed to building an inclusive team where everyone can do meaningful work, grow, and contribute to better healthcare outcomes.