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As the first engineer, you will build the core platform from scratch, owning the architecture, data ingestion, and intelligence layers. You will develop AI-driven agentic systems to transform fragmented health records into coordinated care actions.
The ideal candidate is a high-agency first-principles thinker who has experience building complex systems from the ground up. You must thrive in ambiguity and be capable of making high-leverage technical decisions with minimal supervision.
The typical US senior sees seven physicians across four practices plus insurers, pharmacies, family members, and facility staff. No one has the full picture. Fragmented data in incompatible systems leaves seniors and families managing chaos instead of focusing on living well.
Leland is building the first unified system of record for aging to help seniors live longer, healthier, and happier lives. With one complete record of a senior’s health and life, AI can intelligently analyze the full picture to surface risks, gaps, and opportunities, while the senior’s trusted human navigator guides the next best actions and removes friction so families can actually follow through. This turns fragmented information into proactive, coordinated support that extends healthy, independent years.
We have a multi-year funding runway and are launching pilots in 2026 with providers and already in active conversations with major US health systems. The company is led by a Stanford GSB founder with experience scaling new businesses at Sword Health and Homebase.
As the Founding Engineer, you are our first engineer and the technical leader. You will build the core platform from scratch, owning architecture, data systems, ingestion pipelines, the intelligence layer, and the initial agentic systems that turn a complete record of a senior’s health and life into coordinated action.
We operate through four layers:
Ingest & Store: Pull and structure data from across the healthcare system and combine it with real context on family, caretakers, medications, appointments, and daily life. The goal is one clean, reliable record instead of scattered fragments.
Intelligence: Use AI to continuously analyze the full picture, detect gaps and risks, and prioritize what actually matters.
Action: Build agents that execute real coordination work (scheduling, logistics, reconciliation, documentation) while keeping the human navigator in the loop with full visibility.
Compliance: Make sure every action is properly documented and auditable so the system can scale responsibly.
Expect to make high-leverage technical decisions, ship fast, and own outcomes end-to-end with minimal process. This is a true 0-1 role. You will define how the platform works.
You have built real systems from scratch and take extreme ownership of problems end-to-end.
High agency. You figure things out, move fast, and do whatever it takes to make progress. You don’t wait for perfect requirements or perfect conditions.
You thrive in ambiguity and chaos. You prefer clear goals and maximum freedom over hand-holding and process.
You are genuinely excited to work on hard problems that matter. Fixing broken parts of healthcare for the people who need it most is meaningful to you.
First-principles thinker with strong technical judgment. You make pragmatic architecture decisions and ship high-quality work quickly.
Low ego, high output. You want the intensity and ownership that only exists at the earliest stage of a company.
If you need constant direction, clear roadmaps, or a well-defined role, this is not the right place.
Terrarium is a venture studio that incubates transformational healthcare companies.
Terrarium is a venture studio by Company Ventures building the next wave of transformational health tech startups. The studio incubates companies from -1 to 0 by bringing together exceptional founders, unique insights, capital, and long standing industry relationships.
Offices: New York, NY, US
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