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Senior Application Engineer (Full-Stack)
Location: Ann Arbor, MI
Reports to: Chief Technology Officer
About Town Square Health
Town Square Health is reimagining what healthcare can be. We're building a first-of-its-kind value-based care model with a singular mission: to set the gold standard for how Americans experience healthcare. Our primary care locations offer comprehensive primary care with coordinated specialty support for Medicare-eligible patients, and we're growing fast, with expansion into multiple markets on the horizon.
Our model puts a primary care physician and a dedicated Care Navigator at the center of each patient's care, backed by AI agents that handle the coordination work that traditionally required layers of staff handoffs. We operate under value-based care contracts, which means we succeed when our patients stay healthy, not when we bill more. Our first clinic opens in Rochester, NY, with regional and then national expansion to follow.
If you're bold, collaborative, and driven to make a real difference in people's lives, we'd love to have you on our team!
The Opportunity
This is not a typical senior engineering role.
Town Square Health is seeking a Senior Application Engineer to join our small team working on SquareOne, our custom care delivery and patient engagement platform. You'll work directly with the CTO and a small distributed engineering team, alongside an external design and development partner. The surface area is wide, the stakes are real, and the work directly shapes how clinicians and Care Navigators serve patients every day.
We are an AI-native company: AI is in the product (agents supporting PCPs and Navigators) and in how we build, where we expect fluent, judgment-driven use of AI development tools. The ideal candidate is a senior full-stack engineer who ships production web applications with strong TypeScript, React, and Node experience, has hands-on fluency building with LLM APIs, and is excited to work in performance-critical Rust services.
You'll have the opportunity to:

• Build and ship features that directly support how clinicians and Care Navigators deliver care
• Work on AI-powered workflows that are core to the TSH care model, not a side project
• Operate with real ownership and autonomy on a small, high-trust engineering team
• Help establish the engineering practices that will scale with the organization
• Contribute to a platform that will evolve as we grow from one clinic to many

What You'll Do
You'll work across the full stack of SquareOne, TSH's custom care delivery and patient engagement platform. This means owning features end to end, integrating with clinical systems, building AI-powered workflows, and helping shape how the engineering team operates as we scale. Small team, meaningful ownership, and work that connects directly to patient outcomes.
Application Engineering

• Design, build, and ship full-stack features across SquareOne's product areas: Patient, Clinical, Analytics, and Internal Tools
• Work directly with clinical and operations leaders to translate care workflows into product

AI-Powered Workflows

• Build AI-powered workflows on Temporal, including agentic task handling and care coordination automation
• Apply judgment-driven use of AI development tools to move quickly without compromising quality

Platform & Integration

• Integrate with Athena via its APIs for scheduling, clinical documentation, and operational data
• Contribute to core backend services written in Rust

Engineering Foundations

• Help establish engineering practices, including code review, testing, CI/CD, and observability, that will scale as the team grows

Who You Are
You're a senior engineer who ships. You're comfortable with ownership and ambiguity, and you ask why before you build what. You bring strong technical instincts and the product judgment to know when something is good enough to ship and when it isn't. You're fluent with AI development tools and use them as a force multiplier, not a crutch.
You're energized by the challenge of building something from scratch on a small team, where your decisions have real consequences and your contributions are visible. You communicate clearly, collaborate well, and take pride in code that others can build on.
Most importantly, you believe healthcare can be better - and you want to be part of the team proving it.
Qualifications

• 5+ years building and shipping production web applications, with strong TypeScript, React, and Node experience
• Experience with, or strong interest in, Rust for backend services
• Hands-on experience building with LLM APIs (prompting, tool use, agentic patterns) and daily fluency with AI development tools
• Comfort with ambiguity and ownership: small team, many responsibilities, fast-moving development
• Strong product judgment: you ask why before building what
• Excellent collaboration and communication abilities
• Mission-driven, collaborative mindset and a passion for improving access to high-quality primary care

Strong Pluses

• Healthcare data experience (FHIR, HL7, claims)
• EHR integration work
• Experience in HIPAA-regulated environments

What We Offer

• Starting salary range of $100-140k, commensurate with experience
• Comprehensive benefits package (medical, dental, vision, 401K)
• Flexible hybrid work model based in Ann Arbor, MI
• Opportunity to build something from the ground up
• Direct impact on how care is delivered to older adults
• High visibility and influence in a growing organization
• Collaborative, mission-driven team

Equal Opportunity Employer
Town Square Health is proud to be an equal opportunity employer. We believe that diverse perspectives and backgrounds make our team stronger and our mission more powerful. We welcome and encourage applications from all qualified individuals regardless of race, color, religion, sex, national origin, age, disability, veteran status, or any other legally protected characteristic. At Town Square Health, everyone belongs.