Legion Health (YC S21) | Founding Engineer (AI-Native Ops Infra) | San Francisco | ONSITE | VISA SPONSORSHIP | $130k–$190k + Equity
Legion Health is building the AI-native operations layer for mental health care. We run our own psychiatric practice and use AI agents to handle the complex "backend" of healthcare—scheduling, intake, documentation, billing, and risk detection. We have $3M+ ARR, $7M+ raised, and our infrastructure currently supports 2,000+ patients with only one human support lead.
We're hiring a Founding Engineer to own our backend and agent systems end-to-end. This is not a "wrapper" role; you will be architecting the state machines and event streams that turn clinical intent into reliable operations.
The Role:
Build AI Co-workers: Implement agents with tool use, memory, and safety rails that act as trustworthy teammates for clinicians.
Event-Driven Architecture: Design the schemas and workflows (Node.js/TypeScript/Postgres) that encode how psychiatric care operates.
High Impact: Your work lands in real clinical workflows immediately, directly improving patient access and care quality.
Thank you so much for this comment! Would love to talk to you based on your experience at CareDash here! I see that you have a large network of therapists and have built a pretty impressive B2B directory.
I cannot say that I understand what you are going through right now, but I truly wish you all the best.
We are really trying to help with the issue of access just as you reference here. Wait times are too high to see a psychiatrist so 1) how can we unlock a latent supply of these professionals (by way of their excess time) and 2) in what cases can we substitute these professionals with others whose supply is greater and who can provide similar functions.
Depending on the state that you live in, a psychiatric NP can get you that prescription at a lower cost to you and, more importantly, quicker. We want to allow other organizations to do that for their patients using our providers.
This is a very good point, and thank you for sending this information. However, the infographic is quite misleading because it doesn't stack up nursing school vs. medical school (i.e. it doesn't show the type of courses and training taught in a 4-year nursing program at all). A undergraduate bachelor's degree even in biology is not comparable to the clinical training in nursing school.
That being said, I see your point. There some types of complex care that only MDs/PhDs should be providing, and we will have psychiatrists and doctorate-level psychologists for that care. However, many of the services that our customers provide can be done by other clinicians in our network under the supervision of an excellent MD or PhD.
Part of our goal is to really figure out the "matching" problem so that we can triage care to the clinician type with the right amount of training for the patient situation. By doing that, we feel like we can really increase access the way that we hope.
The matching thing is a solved problem in hospitals. The patient meets a doctor level provider for the first visit then is assigned proper care based on the diagnosis with a lower level provider. The problem you will have is that you have a lot of low level provider with varying skills and a high level provider will have a hard time matching patient to the correct provider capable of administering the correct treatment protocols.
I think this is a very valid point and something that we will need to consider. Thank you for bringing it up. The variation in quality is certainly not easy to solve, especially when pairing it with a clinical decision-making hierarchy.
Totally agree about having to get good at demand forecasting. Good thing we have Daniel; his college thesis involved creating revenue forecasting model for BMW North America that they still use!
You're totally right - no one wants cut rate mental health treatment. If you see my response to Jonni, I explain what our quality process is. Hopefully that convinces you that these aren't cut rate folks and rather very high quality professionals.
And you have good intuition about most of the US health care system, but mental health has some nuances that should be shared. First, many mental health practitioners do not take insurance (only 56% of psychiatrists, for example, take insurance). That makes patients more price sensitive. It's hard to pay $350/hour for help. Secondly, and more importantly, there is a massive shortage of these clinicians relative to demand. Wait times to see a psychiatrist in rural areas can be up to 6 months. That's a big part of the issue that we want to solve: i.e. how can we use our solution to really expand access to the services people need?
You are going after the wrong market. The bottom of mental health is not a money maker. Even if your somehow get more efficiency your margins will suck. Instead go for the best and charge like the best.
Like you described above it’s a 6 month wait to get care from someone decent, so why not charge folks for the opportunity to get care now from the same qualified folks they would have waited months to see?
Your mom need psychiatry meds? Fine we will get someone today or tomorrow no wait but it’s 600$. I’d pay it if it was my mom.
Daughter suicidal and needs to start with someone now? We can do that but there is additional costs.
Want access to that doctor that never has an opening at the regular practice. Well for $300/ 15 min he can see you next week.
Better yet apply sliding airline style pricing and you got a recipe for serious returns
I think you have a valid point here, but we are really trying to be a B2B company because the problems around staffing for other health care organizations are real and they are willing to pay a lot for a more flexible and lower risk solution. What you are describing is B2C and, quite frankly, lower volume. There are other companies that are doing a great job delivering that kind of care, and they are our customers.
Thanks for your question. BetterHelp is a direct-to-patient telehealth company that allows the therapists on their platform to see patients. We are B2B and are trying to provide a better staffing solution for those companies that want to scale or better manage patient demand. TLDR: BetterHelp is a potential customer!
Great question, and I really appreciate you bringing that up. This is one that we get from many of our customers.
First, we have consulted with experts from across health care to implement the most rigorous quality standards for the professionals in our network. Not only do our clinicians have to pass tests of baseline quality (background check, licensure check, etc.), but they are also directly assessed based on their level of clinical expertise, years of experience, education level, etc. We even speak with all of our clinicians to do a basic sanity check and determine how they will present over video.
On the back end, we are currently creating processes to assess post-visit performance in a number of ways, including timeliness, patient satisfaction, etc. That will allow us to weed out lower-quality professionals and reward our higher-quality professionals.
Lastly, a key part of quality in mental health is continuity of care (a longitudinal patient-clinician relationship). Features in our product allow for our customers (health care organizations) to view our clinicians' availability and directly schedule their patients to match that availability, such that the relationship is maintained. Then, we have a number of ways (one of them being highly favorable compensation) to ensure that our mental health professionals stay with us.
I don't know about this. Most psychiatrists I've known have always recommended to meet in person rather than holding something over call. Always set up extra appointments and made time for them at no expense. The ones who would do anything lower than that would come off to me as sub par (and I've had online psychiatrists too, and all of them were subpar).
Interesting observation, and this very much was likely the case for private practice psychiatrists pre-COVID. Now, we are seeing that more mental health practitioners (high-quality included) have become comfortable providing care over video because care quality is actually the same (several studies show this), no-shows are reduced for the psychiatrist (equals more revenue), and patients really prefer it.
Furthermore, psychiatrists who take insurance or who are affiliated with a hospital/telehealth/other health care institution (i.e. not in private practice, plus these are the health care companies that are our customers) are more likely to bill for extra appointments because rates are lower than in private practice (although equal regardless of in-person or over video due to government mandates) and because the customer is less price-sensitive anyway as insurance is footing some of the bill. Therefore, these (still high-quality) folks just have different behavior patterns based on payment and based on response to COVID. I hope that helps.
Do you have a triage system in place where you have a phd level provider that diagnoses and funnels to the appropriate level person to do ongoing treatment? Also why would Good provide join your team what are you offering that makes you competitive to a provider.
I actually really like that idea because it fits into one of our longer-term visions of providing an off-the-shelf turnkey "care team" solution, whereby a cadre of professionals work together to provide care for our customers' patients.
Currently, we don't have such as system in place, but our customer might! In that case, a customer might use a PhD or mD from us to provider higher levels of care and then a social worker or nurse to provide ongoing higher-touch treatment. We are simply providing the health care professionals (and their time) to augment a health care organization's existing staff.
Per your second question, that's actually one of our competitive advantages! Right now, we are finding that many awesome providers who are already reputably employed at a hospital, at the VA, etc are looking to make more money (by the way, the fact that they are already reputably employed is a good screen for quality too). They would like to work an additional 10-40 hours on top of their main job in the mornings, evenings, days off, and weekends. That is a large source of potential supply that is going unused and that could help so many people! Simply put, we offer these providers a chance to make more money by using their expertise to see more patients whenever they want. We provide the patient volume and the competitive rate. All providers have to do is show up and provide the excellent care that they already do.
1) Credentialing is super slow in medicine and probably quite expensive. It will take your provider months to come online.
2) If you aren’t paying high at 65-70% of billable rates you will have trouble finding providers that want to go through all that hassle when they can just work more hours at their regular job.
3) It’s not clear to me that you are doing anything different than what a regular private practice would do. Everyone is full online now post pandemic so they are mostly limited by availability of clinicians. They could hire parts time folks and offer the same deal I think many just choose not to. You would get stuck with all the compliance costs and little actual revenue.
1. Credentialing is definitely super slow. We want to get to the point where we can handle billing for our customers as well, so we'll have to create relationships with payers to speed the process up. Right now, many of our customers and clinicians are already used to this long process, so nothing is really different here.
2+3. We are providing the patient volume at 0 cost to the clinician. This is all just extra income for the clinician at the cost of their time, regardless of whether the clinician is in private practice or working for a hospital with a fixed salary. Opportunity cost requires for the private practice to do marketing, etc to drive patient volume to them. Also, the private practice, again, has the same problems around recruiting and scheduling that a hospital would have.
What you describe is not 0 cost. You take some sort of cut for services provided, that’s what a private practice does. In exchange for patient flow computing scheduling compliance and billing they charge 30-40% of the patient bill.
In a modern work from home environment a provider could contract with a local urban private practice and offer part the hours for the same arrangement. The only real difference is they would have to interview and provide stable ability, the work can be fully remote otherwise. Also typically the practice takes a higher cut if you work fewer hours.
I think that's precisely why we're needed. With the scale that we plan to have, we can actually provide stable patient volume and deal with all the pains of recruiting and onboarding. Every smaller organization otherwise will have too much difficulty piecemealing different clinician availabilities together to create FTE(s)
Legion Health is building the AI-native operations layer for mental health care. We run our own psychiatric practice and use AI agents to handle the complex "backend" of healthcare—scheduling, intake, documentation, billing, and risk detection. We have $3M+ ARR, $7M+ raised, and our infrastructure currently supports 2,000+ patients with only one human support lead.
We're hiring a Founding Engineer to own our backend and agent systems end-to-end. This is not a "wrapper" role; you will be architecting the state machines and event streams that turn clinical intent into reliable operations.
The Role:
Build AI Co-workers: Implement agents with tool use, memory, and safety rails that act as trustworthy teammates for clinicians.
Event-Driven Architecture: Design the schemas and workflows (Node.js/TypeScript/Postgres) that encode how psychiatric care operates.
High Impact: Your work lands in real clinical workflows immediately, directly improving patient access and care quality.
Tech Stack: Node.js, TypeScript, Supabase (Postgres), AWS (ECS/Lambda), Next.js 15, OpenAI/Anthropic.
Offer:
Comp: $130k–$190k base + significant early equity (0.2%–0.8%).
Location: San Francisco (In-person).
Process: Intro -> Systems Deep Dive -> Practical Work Trial (No Leetcode) -> Onsite. We move fast (7-10 days).
Email me at yash@legion.health if you have questions or if you're super cracked and I have to know about you.
Apply here: https://jobs.ashbyhq.com/legionhealth/ffdd2b52-eb21-489e-b12...