AI/ML Engineer 🧠 (LLM Optimization & AI-Driven Workflows) at Legion Health

We’re rebuilding psychiatry from the ground up—AI-native, insurance-covered, and engineered to scale.

Legion Health is a high-quality psychiatry network where patients get care from licensed clinicians, fast and affordably. Under the hood, our LLM agents and orchestration layer automate operations, reduce admin, and enable truly great care.

Most startups bolt AI onto broken workflows. We’re replacing the workflows—and the system underneath.

If you’ve ever wanted to use AI to actually fix something that matters, this is your shot.

Join us in building the most efficient, AI-powered mental healthcare system.

We’re a YC-backed company revolutionizing telepsychiatry—not with AI for diagnostics, but with AI-driven operations that actually make patient care faster, smoother, and more accessible.

We’re hiring top-tier engineers who thrive in high-velocity, AI-first environments and want to build technology that meaningfully improves lives. If you love shipping fast, working with AI, and solving hard problems, keep reading. 👇

• You’ll work on practical AI deployment—optimizing LLM-powered workflows for real-world mental healthcare.

• You’ll refine AI models that improve scheduling, risk assessment, and revenue cycle automation.

• You’ll optimize feedback loops to improve LLM-driven decisions over time.

• You’ll shape a real-world reinforcement learning approach that trains AI on provider feedback.

• Optimizing LLM workflows (fine-tuning models, prompt engineering, integrating feedback loops).

• Improving AI explainability—building systems that show providers why AI makes certain recommendations.

• Implementing retrieval-augmented generation (RAG) for more accurate, context-aware AI responses.

• Building tooling to measure AI override rates, decision accuracy, and improvement metrics.

• Working closely with clinicians to ensure AI improves their efficiency—not replaces them.

• 3+ years experience in AI/ML engineering.

• Strong Python & ML background (LLMs, NLP, PyTorch/TensorFlow).

• Experience with reinforcement learning (or curiosity to implement RL-based workflows).

• Comfortable with production AI deployment (vector databases, API integrations, etc.).

• Interest in AI for healthcare (compliance/security mindset preferred).

• $130-180K salary + 0.4-1.2% equity.

• Real AI autonomy—you won’t just be fine-tuning prompts, you’ll be shaping LLM-driven patient care workflows.

• Work at the bleeding edge of AI deployment in healthcare.

• A mission with impact—we’re solving real problems that affect millions of patients. We are revolutionizing telepsychiatry through a core AI infrastructure that enables a vastly improved patient experience and quality of mental health care. We are actively improving our services in ingesting, chunking, embedding, caching, and searching to achieve this goal. Our technical goals include:

• Enhanced processing: Implement robust data structures and caching mechanisms to handle increasing volumes of language data spanning every facet of patients’ care while minimizing latency and maximizing system responsiveness.

• System scalability: Ensure our systems can scale effectively to support growth from one million to hundreds of millions of data points.

• Securing sensitive data: Uphold the highest standards of data security and privacy in compliance with HIPAA guidelines. ##Stack TypeScript, Node.js, PostgreSQL, Redis, Supabase, Azure, Google Cloud, AWS, LangChain, PostHog, Retool