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Full Stack Engineer

Underdog.io -Apply to top tech jobs in 60 seconds. A place where companies apply to you | New York, New York, United States | Today
full-time | hybrid | lead | 1+ years
skills: react, typescript, python, node.js, llm, agentic systems, vector databases, cloud-native, full-stack, frontend, backend, infrastructure, ai-assisted development, ai/llm integration
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Head of Engineering / Founding Engineer

Build the agentic operating system for accelerating clinical trials. Own the technical vision from day one. Write code, shape architecture, and lay the foundation for a company that will accelerate the drug development lifecycle and get life-changing therapies to patients faster. This is a hands-on founding role.

Underdog.io is a modern recruiting platform. This role is being filled through Underdog.io — a invite-only network of vetted startups and high-growth companies. You won't go through a staffing agency or get passed around. Your resume goes directly to our hiring team and is reviewed by a real human. Your profile is completely confidential. If there's a good fit, you'll hear from us directly — no middleman, no black hole.

The Mission

This company is building the first agentic operating platform purpose-built for clinical trial operations. They partner with clinical trial companies make them more financially resilient, automate administrative burden, and augment people-centric workflows. The goal is simple but profound: accelerate the drug development lifecycle and make a tangible impact on how quickly promising therapies reach the patients who need them.

The platform is being developed in close collaboration with design partners, ensuring that every feature solves a real problem faced every day. The company is backed by top-tier early-stage investors with track records of backing Palantir, Lyft, Gitlab, and Square.

The Role

The company is looking for a founding engineer to own the technical direction and accelerate product development alongside design partners. This is not a managerial role that has been removed from the codebase. This is a hands-on building position—writing code daily while simultaneously shaping the architecture and hiring decisions that will define the company for years to come.

As the first engineering hire, you will set the standard. You will make foundational decisions about the stack, the development process, and the culture of the engineering organization.

What You'll Do

  • Own the Full Stack: Take end-to-end ownership of the technical architecture—frontend, backend, AI/LLM integration, and infrastructure. Every line of code you write will directly shape the product.
  • Build in Lockstep with Customers: Work directly with the CEO and design partners to translate real-world clinical trial site needs into product features. You will ship quickly, iterate based on feedback, and close the loop between customer input and delivered value.
  • Built AI Agents: Design and build agents and systems that don't just retrieve information but actually automate complex, people-centric workflows. You will decide how the platform reasons, acts, and learns over time.
  • Make Foundational Decisions: Choose the technologies, patterns, and tradeoffs that will enable the platform to scale from pilot customers to industry-wide adoption. These decisions will echo for a decade.

Who You Are

  • 1+ Years of Software Engineering Experience: You have shipped production software and understand what it takes to build something that users depend on.
  • Hands-On with LLMs and Agentic Systems: You have built with large language models and are fluent in the emerging patterns of agentic AI. You know how to move from prototype to production.
  • Proficient with AI-Assisted Development: You leverage tools like Claude Code, Cursor, and the modern AI development stack to maximize velocity without sacrificing quality.
  • Strong Full-Stack Fundamentals: You are comfortable across the entire stack and can context-switch between frontend polish, backend reliability, and infrastructure decisions.
  • Bias Toward Shipping: You believe in progress over perfection. You are comfortable with ambiguity and know how to make tradeoffs to deliver value now while laying groundwork for later.
  • Excited by Healthcare and Life Sciences Impact: You don't need domain experience in clinical trials, but you are genuinely motivated by the opportunity to accelerate drug development and improve patient outcomes.

Why Join

  • Ground-Floor Equity: This is founding-team equity in a company targeting a $50 billion+ market that currently has no dominant software solution. The upside is significant.
  • Deep Domain Expertise: The founder has deep domain expertise from leading M&A deals in clinical research and understands the market intimately. You won't be guessing—you'll be building for a space the leadership knows cold.
  • Strong Validation: Industry leaders in the clinical trial category are already on the company's Advisory Board, providing validation, connections, and strategic guidance.
  • Clear Expansion Path: The initial product wedge is clear and defensible, with a visible path to expanding across the entirety of clinical trial operations. You'll be building the platform.

The Stack

You will have significant influence over the technical stack. Current thinking includes:

  • Frontend: React, TypeScript
  • Backend: Python, Node.js
  • AI/ML: Modern LLM tooling, agentic frameworks, vector databases
  • Infrastructure: Cloud-native, designed for scale from day one

Location & Culture

This role is based in New York City. The team believes in the power of in-person collaboration during this founding stage—you'll be working side by side with the CEO and early design partners, moving fast and building something that matters.

Ready to build the operating system for clinical trials?

Benefits

ground-floor equity