Senior Full Stack Software Engineer, Clinical

This role is best suited for a Senior-level full stack engineer with 5+ years of experience who is comfortable owning features end to end, from database design and backend logic to frontend UI and production delivery. It fits someone strong in web fundamentals, SQL, PHP-based backends, and modern frontend technologies who enjoys working across the stack, optimizing legacy systems, and building scalable products with real user impact. The position is ideal for a product-minded engineer who values autonomy, mentorship, fast iteration, and contributing to a mission-driven platform in a remote, agile environment.

1. What parts of the BetterHelp stack do you feel immediately productive with, and where would you expect a slight ramp-up?
   I’d be immediately productive on the front end with React, modern JavaScript/TypeScript, Tailwind/CSS, and on the backend with RESTful APIs, SQL schema design, and query optimization. I’m also comfortable working in a Linux/nginx/MySQL environment and with caching layers like Redis. My main ramp-up would be the specifics of your existing PHP codebase and Twig templating conventions, but my full-stack background and previous experience working outside of frameworks make it straightforward for me to get up to speed quickly.

2. Describe how you would design and ship a new end-to-end feature in the clinical domain, from idea to production.
   I’d start by clarifying the clinical and user goals with product and clinical stakeholders, then propose a simple end-to-end design: database changes, API contract, and the UI flow. Next I’d implement the backend endpoints and SQL changes, then build the frontend with React/Twig, ensuring proper validation, loading/error states, and responsive behavior. I’d cover critical paths with tests, get feedback in staging from clinicians or internal users, then deploy behind a feature flag and monitor metrics and logs to validate behavior and iterate.

3. How do you approach writing and optimizing SQL for a high-traffic application?
   I start with clear, normalized schemas aligned with the access patterns, then write explicit, parameterized queries to avoid injection and keep intent obvious. When performance becomes an issue, I use EXPLAIN plans, add appropriate composite indexes, and denormalize or introduce summary tables where it makes sense. I avoid N+1 patterns from the application layer, batch reads/writes when possible, and use caching (e.g., Redis) for hot reads while keeping cache invalidation logic explicit and predictable.

4. What is your experience with backend security and protecting user data, especially in a sensitive domain like mental health?
   I follow the principle of least privilege at all layers: strict DB permissions, role-based access control in the app, and scoped API tokens. I always use parameterized queries, sanitize and validate inputs, and pay attention to common issues like SQL injection, CSRF, XSS, and IDOR. For sensitive data, I think carefully about what truly needs to be stored, encrypt at rest where appropriate, and ensure logs and analytics never contain PHI or private content. I’m also a big believer in secure defaults: HTTPS everywhere, secure cookies, and consistent auth checks at boundaries.

5. You’ll sometimes need to work without a frontend framework and write “vanilla” PHP/JS/CSS. How comfortable are you doing that?
   Very comfortable. I like frameworks, but I learned web fundamentals without them and still often drop down to raw PHP/JS/CSS to debug or build small, focused features. Understanding how routing, rendering, and the DOM work without abstractions makes me more effective inside frameworks and helps when I need to optimize or debug edge cases. I see frameworks as accelerators, not crutches.

6. BetterHelp ships often and fast. How do you balance speed with code quality and safety in production?
   I focus on small, incremental changes with clear scopes, strong code reviews, and targeted automated tests on critical paths. I rely on feature flags, dark launches, and staged rollouts to reduce risk while keeping iteration speed high. Observability is key: good metrics, logs, and alerts let us catch issues quickly and roll back or hotfix with confidence. The goal is to move fast because we’ve reduced risk systematically, not because we’re ignoring it.

7. Tell me about a time you had to significantly refactor legacy backend code to support new scale or integrations.
   In a previous role, we had a monolithic backend with tightly coupled business logic and SQL scattered across controllers, which made new integrations painful. I gradually refactored critical flows into clear service layers and repository abstractions, consolidating queries, adding tests around the behavior, and cleaning up dead code as I went. This made it possible to introduce new APIs, optimize hotspots, and handle increased traffic without breaking existing functionality, all while keeping risk manageable through incremental changes.

8. How do you collaborate with cross-functional teammates like clinicians, product managers, and designers on clinical features?
   I start by listening: clinicians and PMs bring domain context and constraints I don’t have. I translate their needs into technical options with trade-offs, using simple diagrams or prototypes to keep everyone aligned. I share early demos to validate workflows, especially for anything that might impact clinical safety or user trust, and I’m transparent about limitations, timelines, and risk. My goal is to be a thought partner, not just a ticket implementer.

9. How do you mentor junior developers while still delivering your own work?
   I bake mentoring into the daily flow: pairing on tricky tasks, doing thoughtful code reviews that explain the “why,” and sharing patterns or utilities they can reuse. For some projects, I’ll define the overall design and let a junior dev own a well-scoped piece, supporting them with regular check-ins and feedback. I also encourage them to propose improvements or small refactors, since teaching them to think critically about the codebase multiplies the team’s long-term impact.

10. Why does working as a Senior Full Stack Engineer at BetterHelp appeal to you personally?
    I care deeply about mental health, and the idea that my work can directly make therapy more accessible and less stigmatized is very motivating. Technically, I like owning features end-to-end, working close to production, and iterating quickly in a mission-driven environment. BetterHelp’s combination of scale, impact, and startup-like agility is exactly the setting where I can use my full-stack skills, keep learning, and contribute to something that genuinely improves people’s lives.

This position is a strong match for a mid-to-senior full-stack web engineer in the US who enjoys owning features end-to-end in a LAMP/LEMP-style SaaS environment—someone comfortable building products in PHP/MySQL/Redis on the backend, crafting UIs with Twig, React, jQuery, Tailwind/Bootstrap, HTML5, and CSS/SASS on the frontend, writing performant SQL and backend algorithms, and working in a fast, continuously-deployed, mission-driven mental health product where you’ll mentor juniors, touch product decisions, and earn $130K–$185K base + bonus, 401(k) match, strong health benefits, and fully-remote work with a few yearly trips to San Jose.