Backend Engineer (Python) - Remote in Europe

Description About Gather Health Gather Health is a Boston-area primary care practice serving adults 65 and older, many of whom face barriers to accessing care and support. We believe care is fundamentally human: the relationship between a patient and provider is foundational to helping people live well. We work under a value-based care model: we are paid for keeping patients healthy, not for the number of visits we provide. Catching problems early and preventing avoidable hospital stays are central to how we operate, and we build technology that gives care teams more understanding and time to strengthen their relationships with patients. The Role We are looking for a mid-level Backend Engineer to help build Esther, our AI voice agent and a core part of Gather Connect, our platform for supporting patients between visits. Esther calls patients for regular check-ins and support after a hospital discharge, in English, Spanish, Portuguese, and Vietnamese. She helps us understand how patients are doing and connects their needs to the people who can help. You will build the Python services that make those conversations useful: deciding when to call, bringing the right patient context into a conversation, and turning what a patient shares into reliable follow-up. Our next steps include more control over call timing and frequency, appointment scheduling, medication refill requests, and referral follow-up. This is a hands-on individual contributor role on a small engineering team based in Germany, Spain, and Italy. You will own well-scoped features from technical design through deployment, with support and review from other engineers. You will work closely with product, design, and clinical operations to understand how your work affects patients and care teams. What You Will Work On • Build and extend APIs, data models, and background workflows for patient enrolment, call scheduling, preferences, and follow-up. • Connect Esther with our electronic health record and clinical data platform so conversations use relevant patient history and requests reach the right care team. • Help patients complete care tasks, including scheduling appointments and requesting refills, with clear handoffs and visibility into what happens next. • Improve the voice agent’s access to context and tools and support more personalized conversations across languages and care programs. • Make workflows dependable when calls drop, webhooks arrive twice, or external services fail. • Write tests, review code, investigate production issues, and ship compatible changes across separately deployed services. Treat patient privacy and secure data handling as part of everyday engineering. Our Stack Our stack includes Python with asynchronous FastAPI, PostgreSQL, Google Cloud Platform (GCP), LiveKit Agents, and Terraform. We integrate speech recognition, large language models, and text-to-speech to power Esther’s conversations. Requirements What We Are Looking For • Experience shipping and maintaining backend services in production. We care more about what you have built and owned than an exact number of years. • Strong Python skills and experience building HTTP APIs with FastAPI or a similar framework. You should be comfortable working with asynchronous code. • Practical experience with PostgreSQL or another relational database, including data modelling and schema migrations. • Experience integrating third-party APIs and working with background jobs or queues, including handling timeouts, retries, and partial failures. • Good engineering habits: readable code, useful automated tests, code review, and debugging with logs and metrics. Experience deploying containerized services to a cloud platform. • Ability to take a defined problem through to a working release, ask for help when needed, and communicate decisions and progress clearly in English across a distributed team. Nice to Have • Experience with GCP, Terraform, or OpenTelemetry. • Experience with LiveKit, telephony, voice agents, or integrating and evaluating LLM-powered features. • Experience with healthcare systems, sensitive personal data, or workflows where reliable follow-through matters. • Spanish or Portuguese language skills, which help when reviewing and improving Esther’s conversations. You do not need prior healthcare or voice AI experience, or experience with every tool in our stack.\ How We Work You will collaborate with our European engineering team and product, clinical, and operations colleagues in the US. We value people who are direct, practical, kind, and reliable, and who enjoy understanding a problem, making something tangible, and improving it together. We reserve 14:00–18:00 Central European local time (CET/CEST) each working day for collaboration with US colleagues. You should be available throughout this window for discussions, pairing, and shared problem-solving, with focused work between conversations. We also work asynchronously. The role has no on-call responsibilities. Location and Contract • You can be based in Spain, Italy, Portugal, Poland, Germany, or Greece. • This is a full-time, permanent role on a local employment contract through our employer of record. • Salary: €65,000–€90,000 gross annually, depending on experience and location. Why Join Build a live product used by patients and see how your work supports their care. You will have meaningful ownership in a small team, room to deepen your backend and applied AI skills, and a business model built around keeping people healthy.