Founding Principal Engineer

Founding Principal Engineer

Location: New York City

Working pattern: Hybrid — at least three days per week in the office, with significant in-person collaboration during the first year and more flex in the future

Salary: $230,000-$250,000

Equity: 0.3-0.8% (an organisation with an already significant valuation)

Technology: TypeScript, Node.js, React and AWS

What's the opportunity?

We're working with an established, growth-stage healthcare company to appoint its first senior onshore engineering hire.

This is a Founding Principal Engineer position offering the influence of an early technical hire without the uncertainty of joining an unproven business. The company already employs approximately 200 people across clinical care, operations, growth and leadership, and its services are actively helping children, young people and their families access high-quality mental-health support.

You'll work directly alongside the CEO and initially be one of a very small number of engineers based in New York. You'll have substantial influence over the product, architecture and engineering organisation the company builds next.

Despite the founding title, this is not a conventional engineering-management role. The company needs an exceptional product engineer who still wants to write code, personally solve difficult problems and make important technical decisions without relying on someone more senior to provide the answer.

Why the company exists

Accessing appropriate mental-health support for a child can be slow, expensive and confusing. Families regularly face long waiting lists, limited insurance coverage and difficulty finding clinicians with the right specialist experience.

This company is building a more accessible alternative: a modern care model combining technology, virtual services and clinical expertise to help families find appropriate support more quickly.

The focus is not simply on increasing the volume of care. Its clinical model is grounded in evidence-based treatment, measurable outcomes and close involvement from parents and caregivers. The aim is to help young people make meaningful progress while developing practical skills that can support them throughout their lives.

The organisation is already delivering care at scale and seeing measurable improvements for the families it supports. Technology is central to how that care is accessed, managed and delivered, making this an opportunity to build products with a direct and visible human impact.

Why now?

Following a recent investment round, the company is accelerating its product roadmap and beginning the next stage of its technical development.

It currently works with an offshore engineering team and is now establishing a small, high-calibre onshore capability. You'll lead that technical transition, introduce stronger engineering practices and help determine which capabilities should be built internally as the company grows.

You'll be joining at a point where the organisation already has meaningful scale, specialist expertise and a proven service model, but its future engineering organisation is still to be defined.

Over the following 6-12 months, you'll help lay the foundations for a small New York engineering team. As that team develops, there is potential for the position to expand into broader technical or engineering leadership. The immediate priority, however, is finding an outstanding engineer who wants to build rather than someone looking to move away from the code.

What will you do?

You'll write production code and personally own the company's most challenging engineering problems across its consumer, clinical and internal platforms.

Working directly with the CEO and alongside clinical, operational and growth teams, you'll turn complex or loosely defined needs into practical product and technical plans. You won't always receive a detailed specification, so you'll need to question assumptions, understand the underlying problem and decide what users and the organisation genuinely need.

You'll take ownership across the entire product journey, from requirements and architecture through backend implementation to the user interface.

You'll work closely with the existing offshore engineering team, identify where the current model is succeeding or struggling and help manage the transition towards an onshore capability. You'll also establish appropriate standards around architecture, testing, code review and quality.

Knowing what not to build will be equally important. You'll need the judgement to buy rather than build, reduce scope, simplify a proposed solution or stop work that no longer provides sufficient value.

You'll also identify responsible, practical opportunities to use AI to accelerate the product roadmap and improve how the wider organisation operates.

How the company works

The culture reflects the responsibility that comes with building healthcare products used by clinicians, young people and their families.

Teams are expected to put patients first, act thoughtfully when the correct decision is difficult and ground their work in evidence. At the same time, the organisation values adaptability, continued learning, diverse perspectives and close collaboration across technical, clinical and operational disciplines.

For an engineer, those principles have real consequences. Clinical correctness, patient trust and data quality matter. The business needs someone who can move quickly and innovate without adopting a "ship now, fix later" approach to problems where failure could affect the quality or availability of care.

You'll be encouraged to challenge ideas, interrogate unclear requirements and bring a strong technical perspective while respecting the expertise of the clinicians and operational teams around you.

What will you bring?

Tech Stack - Required Hard skills

Production full- stack TypeScript (Node + React + AWS)

Hands- on AI/LLM implementation in production systems

Broader context requirement

You'll have at least six years of software engineering experience and clear evidence that you have personally owned meaningful product and technical decisions.

You'll still be writing significant production code today, with strong full-stack experience and the ability to take ownership from requirements through to the user interface.

Experience with TypeScript, Node.js, React and AWS would be valuable, although comparable experience will also be considered.

You'll have operated in an early-stage, growth-stage or resource-constrained environment where the technology, processes and team structure were not already established. You should be able to explain the decisions you made, what happened as a result and what you changed when things went wrong.

Experience working with offshore or distributed engineering teams is highly desirable. The company will want to understand what challenges you encountered, how you identified them and the practical changes you introduced.

Strong product instincts are essential. You should naturally explain why a product was built, the problem it solved and how it affected users—not only describe its architecture.

Experience in healthcare would be advantageous, particularly where clinical correctness, sensitive data or regulatory scrutiny were involved. Fintech or another regulated, high-consequence consumer environment could provide an equally relevant background.

This role is unlikely to suit someone who has moved fully into engineering management, worked exclusively within mature big-company platforms or specialised solely in either backend or frontend development.

What's in it for you?

You'll become the first senior onshore engineer within an established, approximately 200-person healthcare organisation working on a problem with a clear social purpose.

You'll work directly with the CEO, influence product and company decisions, shape the technical foundation of a complex care platform and establish how the future engineering organisation operates.

The products you build could help a family access care sooner, provide clinicians with better information and enable the organisation to support more young people without compromising the quality of its services.

You'll have meaningful autonomy, a broad technical remit and the opportunity to build a team and engineering culture around principles you believe in.