Lead Engineer

Own a large share of the software today, and grow into leading engineering as Outro scales. About Outro Outro Health is the first company dedicated to helping people feel better by using less medication, not more. Our flagship program helps people safely taper off antidepressants and other psychiatric medications through specialist clinical care and purpose-built software. Our clinical work is led by co-founder Dr. Mark Horowitz, one of the world's foremost experts in deprescribing and author of the field's leading clinical textbook. In our first year, we built a first-of-its-kind care model with real revenue, healthy economics, and research partnerships with leading health systems and universities. Our software helps a small clinical team taper patients safely while reaching far more of them. Our next phase is refining that model and scaling it. More on us: our launch in WIRED and Dr. Horowitz on NPR's Science Friday . The role Outro has effectively had one engineer to date: our founding engineer, who built most of the patient product, clinician tooling, internal systems, and technical foundation. He is now moving into a Product Lead role focused on finding and shaping what we should build. He will still write code—prototyping ideas, launching experiments, and helping teams move quickly when software can unlock progress. We are hiring a Lead Engineer to take primary ownership of engineering. You will be Outro's senior hands-on engineering leader: writing a large share of the production software, making important technical decisions, and ensuring our systems remain coherent, reliable, and built to last. As you hire and lead the engineers who come after you, this role is intended to grow into Head of Engineering. There is no existing team to manage: the role is deeply hands-on today and will remain so as we build a small, excellent engineering organization. What you'll own Near term, you ship. You will design, build, and operate systems across: clinician tools and patient-facing products; medication, symptom, and clinical data; insurance and healthcare integrations; internal operations and research systems; infrastructure, reliability, security, privacy, and compliance. Almost everything we build comes back to one question: what is happening with a patient's medication, how are they responding, and how should we support them? In deprescribing, forms, messages, prescriptions, and notes disagreeing is not merely untidy; it is a patient-safety risk. You will own the systems that make this information coherent, useful, and safe to act on. As we grow, you will increasingly own technical direction, architecture, engineering standards, delivery, and technical compliance—including how we approach HIPAA, SOC 2, access controls, auditability, and sensitive patient data. You will hire and mentor subsequent engineers, introduce useful process without unnecessary bureaucracy, and ultimately lead engineering as a function. How we work together Both the Product Lead and Lead Engineer write code. The distinction is accountability, not a handoff: the Product Lead owns product discovery and rapid experimentation; you own the engineering system those bets live within—its architecture, quality, reliability, and evolution. Sometimes you will build together; sometimes independently. You will help shape ideas early and be a genuine thought partner on product and technical strategy, not simply receive finished specifications. Who you are You are likely a strong Senior or Staff Engineer at an early-stage healthcare or technology company. You want to own engineering as a whole, but still love building and do not want to move into full-time management. You have: shipped and operated substantial production systems; strong judgment across architecture, data modeling, product engineering, and integrations; real product instinct and comfort working through ambiguity; high standards for reliability, especially where software affects patient care; serious experience building with AI tools—and know where they help and where they fail. Healthcare or regulated-industry experience is useful, but not required. Sound judgment, curiosity, and the ability to learn a complex domain quickly matter more. Stack and team We use TypeScript across most of the stack: Node.js, Next.js, React, Vite, React Native, Postgres, BigQuery, GCP, and Terraform. You will work closely with our Product Lead, founders, clinicians, operators, and a part-time designer. We intend to stay small, with substantial individual ownership and low bureaucracy. We work Eastern hours. Join us in New York City or work remotely within the US or Canada. Compensation and benefits Salary: $165,000–$220,000, based on experience Equity: 0.5–0.75% Health: $1,000 per month through Thatch ($250 more per dependent) to choose your own medical, dental, and vision plan Time off: 20 days of paid vacation, plus holidays Tooling: Claude, Codex, Cursor, and whatever else you need Please apply even if you do not meet every qualification. Nobody does, and we would rather talk.