Senior Backend Engineer II - Patient Experience

About Us At Prenuvo, we are on a mission to flip the paradigm from reactive “sick-care” to proactive health care. Our award-winning whole body scan is fast (under 1 hour), safe (MRI has no ionizing radiation), and non-invasive (no contrast). Our unique integrated stack of optimized hardware, software, and increasingly AI, coupled with the patient-centric experience across our domestic and global clinics, have allowed us to lead the change against “we caught it too late again". We're looking for a Senior Backend Engineer II to join our Patient Experience team and own the communications platform that keeps patients informed throughout their journey: booking confirmations, appointment reminders, intake nudges, results notifications, and follow-ups across email, SMS, and push. You'll also build on the patient-facing APIs behind our patient dashboard (web) and native mobile apps (iOS and Android). Our in-house Python communications service converts event bus domain events into patient messaging via Iterable, AWS SES, SMS, and push. Key challenges involve ensuring reliable, exactly-once delivery, respecting consent and preferences, and gracefully handling vendor failures with detailed logging. We seek engineers who thrive on end-to-end system ownership, resilient event-driven architecture, and driving outcomes over tickets. Our preference is for candidates based in Vancouver, who can accommodate a flexible hybrid arrangement during the initial onboarding period. This role does not provide visa sponsorship. Applicants must be legally authorized to work in Canada at the time of hire and must not require employer sponsorship for a work visa (current or future). Help reshape the world through proactive healthcare while working with cutting-edge technology and high performing teams with deep expertise - join us to make a difference in people’s lives! What You’ll Do • Own the communications platform: Own the patient communications platform end to end, from design through rollout, including service architecture, on-call standards, and technical roadmap. • Develop complex software solutions: Build and maintain scalable backend services using Python, FastAPI, and AWS event-driven services (EventBridge, SQS/SNS, Lambda, ECS) that power patient communications. • Deliver reliably: Guarantee reliable, exactly-once message delivery through retries and failures, using idempotency, deduplication, backoff, and dead-letter handling and replay, with a clear status for every message we attempt. • Build in consent: Build consent and preference handling into the send path, including channel and category opt-ins, STOP and unsubscribe propagation across systems, quiet hours, and clean separation of transactional and marketing messages. • Make sends safe: Build safe tooling for one-off and bulk patient sends (audience preview, test sends, rate limits, kill switches) with least-privilege access to patient data and vendor credentials, so that a production send is always a deliberate, reviewed action. • Evolve patient-facing APIs: Design and ship OpenAPI-first endpoints that follow our versioning and backward-compatibility standards for mobile clients we can't force-update, and help migrate consumers off legacy GraphQL. • Ensure system reliability: Lead improvements in reliability, observability, and incident response using Datadog. You are accountable for whether a message actually reached the patient, not just whether the code merged. • Raise engineering quality: Write comprehensive automated tests for the services you build, and improve the patterns, tooling, and processes that raise quality across teams. • Provide technical guidance: Lead design discussions, review technical implementations, and mentor engineers across levels. • Influence technical direction: Contribute to architectural decisions and the long-term evolution of the platform, partnering closely with Product, Design, Lifecycle Marketing, Clinical, and other engineering teams. • Use AI-assisted development: Use AI coding tools and agentic workflows thoughtfully as part of a structured build, review, and test workflow. What You’ll Bring • 7+ years of backend engineering experience owning production services, ideally in Python (or a similar language such as Ruby, Go, Node.js) • Strong experience designing and building REST APIs, including contract design, versioning, and error handling, in a modern backend framework (e.g., FastAPI, Flask, Django, Express, Spring). • Hands-on experience with cloud platforms such as AWS, including event-driven systems (EventBridge, SQS/SNS, Lambda, ECS), and modern CI/CD practices. • Experience building and maintaining distributed systems and integrating with external APIs and webhooks, including idempotency, retries, rate limits, and partial failure. • Deep knowledge of relational databases, particularly PostgreSQL, plus experience with NoSQL (e.g., DynamoDB) and caching (e.g., Redis). • Experience implementing authentication and authorization (OAuth2, JWT, service-to-service security). • Experience writing comprehensive backend tests (e.g., Pytest) and ensuring strong test coverage. • Experience with monitoring and observability tools such as Datadog or similar platforms. • Ability to independently lead complex initiatives, make sound technical decisions, and balance short-term delivery with long-term maintainability, including on-call and incident response for what you own. • Ability to break down complex projects into components or milestones that other engineers can easily pick up. • Comfortable with ambiguity, able to balance speed with quality, and willing to take ownership from design through production. • Excellent communication skills and the ability to collaborate across engineering and business teams. Nice to Have • Experience with Iterable or a similar customer engagement platform (Braze, Customer.io, Klaviyo, Salesforce Marketing Cloud): event and user-profile APIs, journeys and workflows, message types and channels, and webhook processing. • SMS experience at scale: Twilio or similar providers, 10DLC and short codes, opt-in capture and STOP handling, and TCPA and carrier compliance. • Push notification experience: APNs and FCM (directly or through a platform), device token lifecycle, and deep linking into mobile apps. • Email delivery experience: AWS SES or similar, SPF/DKIM/DMARC, bounce and complaint handling, and suppression lists. • Notification orchestration: multi-channel routing, preference centers, frequency capping, and scheduled or reminder-based messaging. • GraphQL experience, Backend-for-Frontend patterns, or close partnership with native iOS/Android teams. • Familiarity with FHIR or other healthcare data models. • Familiarity with Terraform, Docker, and GitHub Actions. • Experience working in highly regulated industries, including handling sensitive health data. Our Values First: we are Pioneers • Transforming healthcare requires divergent thinking, bias for action, disciplined experimentation, and consistent grit and determination to maintain momentum. This journey is as challenging as it is rewarding. Second: we are Platform-Builders • We’re always building foundations that allow us to achieve tomorrow more than we did today. We never lose sight of what’s ahead – in a mindset of ownership and duty to our mission. Above all: we are Patients • We could all be the next person who walks through our very doors, seeking clarity or peace of mind. We are proud of our impact on our patients’ lives, and we won’t stop till everyone can benefit from our work. What We Offer • An avenue to make a positive impact on people's lives and their health • We believe in preventative healthcare for everyone, including our team - Prenuvo provides free, whole-body scans to each team member • Growth opportunities are at the heart of our people journey, we’re doing big things with bright minds - there is no single path to success, it can be shaped along the way • Building strong relationships is at the core of everything we do - our team gets together each week to connect, share, and socialize • Recognizing time away to restore is vital to our wellbeing - we have a flexible vacation policy and we will encourage you to use it • We offer a comprehensive benefits package including health, dental, vision, including Mental Health coverage, to support you and your family • Prenuvo offers eligible Canadian employees access to both RRSP and TFSA retirement savings plans, with immediate, optional enrollment and the flexibility to invest and save for the future on your own terms. While Prenuvo provides access to these plans, the company does not currently offer matching contributions. • The base salary for this role ranges from $145,000-$160,000 in local currency, depending upon experience and geographic location We are an equal-opportunity employer and value diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status. As part of the hiring process, successful candidates will undergo a background check in compliance to applicable federal, provincial, and state rules. Please be advised that official communication from our recruitment team will only come from our authorized domain [prenuvo.com]. If you are contacted by a recruiter, please ensure their email address ends with @prenuvo.com. We do not use third-party recruitment services or any other email domains for hiring purposes. If you receive communication that you believe to be fraudulent, please report it immediately to jobs@prenuvo.com.