Midstream is an AI-native financial operating system for health systems, founded by experienced entrepreneurs and backed by top-tier investors. We give finance, supply chain, and managed care teams real-time visibility into where margin is at risk, with a precise action plan for capturing it before it's gone.

Purpose-built for healthcare's complexity, Midstream transforms structured, unstructured, and external data into instant, contract-aware insights that drive smarter decisions. Our AI agents unify spend and revenue operations across the full back-office, learning and adapting with every interaction and delivering always-on intelligence that no point solution or one-off engagement can match.

We're compressing months to minutes and turning post-period hindsight into in-the-moment foresight. The tempo of healthcare finance is changing, and Midstream is leading it.

The Opportunity

This is a rare opportunity to join Midstream at a formative stage and help shape the technical foundation of the platform. You’ll work at the intersection of product, systems, and cloud infrastructure, designing and building the distributed systems that allow a small team to move fast, safely, and with confidence as the company scales.

You’ll partner closely with engineers and leadership to understand where infrastructure creates friction today, and where it will quietly break tomorrow if left unaddressed. From multi-tenant architecture and security boundaries to developer workflows and observability, you’ll turn ambiguity into durable systems that reduce operational overhead and compound engineering velocity.

We’re looking for a systems-minded software engineer who cares deeply about long-term maintainability and developer experience, but who also loves developing backend services and shipping a real software. Someone who can reason about distributed systems, make pragmatic tradeoffs, and build infrastructure that fades into the background, so the team can stay focused on delivering meaningful product value.

What You’ll Do

• Build shared platform patterns and tooling that help engineers ship new backend services and workflows quickly, safely, and consistently.

• Strengthen the reliability of our production systems by improving observability, debugging, and resilience as we scale.

• Design infrastructure that is clean, reviewable, and repeatable—reducing one-off configurations and enabling faster iteration.

• Establish clear and scalable multi-tenant boundaries across data, compute, and identity to support enterprise healthcare customers.

• Help ensure the team can spend more time building new capabilities—and less time maintaining systems—as customer usage and data volume grow.

• Build the agentic orchestration layer for tools and and agents to power our natural language analytics that enables rapid discovery of insights with source document traceability.

Who You Are

• You have strong instincts for designing distributed systems and scalable SaaS platforms, with a focus on clear ownership, isolation, and reliability. You understand core platform building blocks like API design, CI/CD, multi-tenancy, and role-based access control, and you build systems that are secure and resilient without unnecessary complexity.

• You’re deeply comfortable in modern cloud environments (AWS or GCP) and have experience using infrastructure-as-code tools like Terraform and Kubernetes. You know how to leverage cloud-native services for computing, storage, and ML-enabled applications as the platform grows.

• You treat infrastructure as software and care about developer experience. You enjoy creating reusable patterns, templates, and automation that help teams ship faster with fewer operational burdens.

• You’re a strong backend engineer who writes high-quality services and pipelines. You’re comfortable building APIs, asynchronous workflows, background jobs, integrations, and foundational systems—balancing infrastructure leadership with delivering real product functionality.

Why Midstream

• Impact from day one: Help define our product, processes, and customer experience from the ground up.

• User-focused culture: Spend real time with customers, shaping a product that reflects their world.

• High ownership: Drive ideas from discovery to delivery with autonomy and trust.

• Exceptional team: Work alongside experienced founders, engineers, and operators with deep healthcare and AI experience.

• Meaningful work: Build technology that helps healthcare systems operate smarter and sustain care for more people.