Company: Metric Tree Labs (dedicated engagement with a US healthcare client)

Location: Remote, India

Experience: 5–6 years

Type: Full-time | Openings: 2

About Metric Tree LabsMetric Tree Labs is a Kochi-based product engineering company. We build dedicated remote engineering teams for global clients. Our engineers work as full members of the client's product team while being employed and supported by MTL.

About the ClientOur client is a US-based healthcare technology startup founded by Harvard Business School alumni. They are building a modern healthcare product for the US market that helps hospitals, research sites and pharma companies find and engage patients for clinical trials. The platform connects to electronic health records (EHRs), screens patient data against trial criteria using AI, and supports patient outreach through AI-powered SMS and voice.

The client wants a strong full-stack engineer who will:

- own features end to end, from design discussions through production deployment
- grow with the product

What You'll Do
- Build EHR integrations. Connect to Epic, Oracle Health (Cerner), eClinicalWorks, athenahealth and OncoEMR using FHIR R4 and SMART on FHIR. This covers:
- OAuth flows and token refresh
- patient data retrieval and bulk exports
- recurring synchronization
- Build reliable data pipelines. Write ingestion workers that handle:
- pagination and API rate limits
- retries and checkpoints
- duplicate records and partial failures
- Model clinical data. Normalize patients, conditions, medications and other FHIR resources into PostgreSQL, preserving source evidence and clinical context.
- Ship product features. Build clean, usable Next.js/React interfaces for patient records, eligibility review, screening and trial workflows.




- Extend AI workflows. Work on document parsing, criteria extraction, patient matching, and AI-assisted SMS/voice screening using LLM APIs.
- Build secure backend APIs. Deliver REST APIs, webhooks, role-based permissions and audit trails that handle sensitive patient data correctly.
- Own delivery. Write tests, review code, document decisions, deploy on AWS, monitor production and fix issues.

Must-Have Skills
- 6-8 years building and running production web applications, with clear examples of features or services you personally owned end to end.
- Strong TypeScript/Node.js backend skills. NestJS or Express is a plus.
- Hands-on React and Next.js, with the ability to build a clean, functional dashboard quickly.
- Solid experience consuming third-party REST APIs, including:
- OAuth 2.0 authentication
- cursor/link-based pagination
- handling 429s and rate limits
- retries with backoff
- error handling
- Solid PostgreSQL skills: data modeling, migrations, indexing, and idempotent upserts so that re-running a sync never creates duplicates.
- Experience with background jobs, queues or data pipelines, and with designing them to recover safely from failures.
- Comfort deploying on AWS and Vercel, and working with Docker.
- Ability to pick up unfamiliar APIs and vendor documentation fast, and to work independently.
- Clear written communication.



You should be able to explain your approach, trade-offs and design decisions in a README or design note.

Strongly Preferred
- Hands-on FHIR R4 experience: Patient, Condition, MedicationRequest and related resources, Bundles, search parameters and _lastUpdated-based incremental sync.
- SMART on FHIR authorization, including standalone launch, backend services and JWT client assertions. Experience registering apps on Epic, Oracle Health/Cerner or athenahealth developer sandboxes.

- Familiarity with FHIR Bulk Data ($export) and HL7 v2.
- Experience moving integrations from sandbox to live customer environments.
- Experience working with PHI under HIPAA or SOC 2 practices.
- Experience with LLM APIs in production: structured outputs, retrieval/pgvector, evaluation, and managing cost and latency.
- Exposure to Drizzle/Prisma, AWS CDK, SQS/ECS, Twilio or ElevenLabs.

Tech EnvironmentTypeScript, Node.js, Next.js, React, Tailwind, NestJS, PostgreSQL (Aurora), Drizzle, AWS (SQS, ECS Fargate, S3, CDK), Redis, FHIR R4, SMART on FHIR, OpenAI APIs, Twilio, Vitest and GitHub Actions.

You don't need experience with every tool listed. Strong fundamentals and the ability to learn fast matter more.

Selection ProcessThe process has four steps:

1. Profile screening
2. Technical discussion with MTL
3. A practical take-home assignment involving real healthcare API integration, submitted as a deployed app, a repo and a README
4. A final interview with the client's founder

Why Join
- Work directly with a US founder and a small, sharp engineering team.
- Take real ownership across a live healthcare product, EHR integrations and applied AI.

📌 Senior Full-Stack Engineer – Healthcare AI & EHR Integrations (India)
🏢 Metric Tree Labs
📍 India