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ENGINEERING AT NURX

Building Solutions that Make Healthcare Better

The problems with the American healthcare system are well-known: It’s often slow, expensive, confusing, and as patients, we don’t have many choices in how we take care of ourselves. At Nurx, we’re building a solution in the form of a platform that gives patients access and control.

As technologists, we strive to streamline the patient experience (by doing away with a lot of the appointment scheduling, waiting, and repetitive questions you have to answer) and allow our providers to focus on the essential work of guiding patients to the right care, and nothing else.

To do this, we’ve had to tackle the full primary care “stack.” We build the tools our patients use to interact with doctors, the tools our doctors use to oversee care, our own customer service tools, and the software that operates our pharmacy.

We take a lot of pride in what we do, and how we do it. We’d love for you to join our diverse team today, and to help us continue to scale our model within the US and beyond.

Why Work At Nurx?

Nurx is reinventing healthcare, by making it easier to get vital medications and tests delivered straight to your door. Learn what it's like to work at Nurx.

Got Questions?

  • Why full stack healthcare at Nurx?

    Building tools for patients, doctors, customer service associates, and pharmacies is hard. Integrating with insurance companies makes that problem even more difficult. Why do we bother? Simple: We know that a lot of the waste and frustration arises where these systems don’t interface well together, and we’re excited by the challenge of fixing this.

    Consider birth control. Even women who have insurance and live near a doctor face inconvenience and expense when trying to access a prescription. Waiting months for an appointment, missing work to see the doctor, standing in line at the pharmacy, and then discovering that her birth control prescription isn’t covered by her insurance plan or has a hefty copay — this is the inefficient and unreasonable experience many people face today. The situation is even worse for people who don’t have insurance, don’t live near a provider willing to prescribe birth control, or simply don’t have the time or money necessary to overcome the obstacles between them and essential healthcare.

    We believe that the only solution here is to integrate that process, so providers can understand costs and insurance coverage before they write a prescription, and provide personalized care on the patient’s schedule, from wherever she is (no appointments or office visits required). We want pharmacists to focus on ensuring a patient’s medicine is safe and doesn’t interact with other prescriptions, not fielding faxes from her provider or waiting on hold with her insurance company. To do that, everyone needs real-time visibility up and downstream, and we need to eliminate the wasted time capturing and re-entering data. That’s why we’re going full stack.

  • How do we build it?

    We like to think of ourselves as small, and just starting on a long journey to be the biggest primary care provider in the US. As engineers, we want to keep our stack simple as long as we can so it’s easy-to-read code, support it in production, and change it when we need to evolve. We also don’t sell our software, we build it for ourselves, so we can learn and adapt quickly.

    That usually means we prefer tools that have a strong community, stable APIs, and provide some security updates and monitoring. We also like things that are easy to debug when they break.

    Here’s how our stack breaks down by team:

    Core Platform, Patient Experience, and Operations

    • Languages: TypeScript (some JavaScript, but we’re migrating)
    • Databases: PostgreSQL, Redis
    • Frameworks and Tools: Express, Knex, Ember, Bootstrap
    • Object storage: S3

    Data and Machine Learning
    • Languages: Python, R
    • Databases: PostgreSQL, Presto (Amazon Athena)
    • Frameworks and Tools: Mode Analytics, DBT, Tensorflow, Fiona/Shapely (GIS)

    Mobile Applications
    • Languages: Swift (iOS), Kotlin (Android)

    Core Infrastructure and Shared Tools
    • Hosting: AWS
    • Ticketing: Phabricator
    • Wiki and Collaboration: Google GSuite, Salesforce Quip
    • Monitoring and Telemetry: New Relic (APM, Synthetics, Infrastructure), CloudWatch, StatusCake
    • Log Analysis: Splunk
    • Oncall Management: PagerDuty
    • Communication: Slack, WebEx

    In case you’re wondering where Docker, Kubernetes, and the other hot tools are, we don’t need them (yet) because our infrastructure is still somewhat small (<100 hosts.) It’s still easier for us to manage larger services directly within AWS, and it’s a lot simpler. We know that will change as we grow, but will hold until it’s needed and beneficial.

  • What is company culture like at Nurx?

    Last year, our leadership team took a look at our company values and made several revisions. Our goal was to define a set of values that underscores our focus on judgment-free access to healthcare and desire to prove how a product-focused mindset can help change healthcare.

    In a nutshell, our values are:

    • We are patient-first
    • We dare to be better
    • We are in this together
    • We own it
    • We do the right thing


    We’re also growing as a team. In addition to our San Francisco headquarters and fully-owned pharmacy in Syracuse, in 2019 we moved our Miami nursing and customer service teams out of a coworking space (they’d almost taken over an entire WeWork) into our own office, and launched a new Boulder office for Engineering and Machine Learning. We’re now more than 250 people, and growing!

  • What is engineering culture like at Nurx?

    In addition to our company values, the Nurx engineering team has a few other areas of focus:

    • Craftsmanship. We care about the quality of our work, and strive to make it stable and easy for others to understand and modify. We’re thoughtful about how today’s seemingly small decisions can have an outsized impact on our code tomorrow in terms of how easy it will be to maintain, how expensive it will be to operate, and how strictly we can maintain its security.
    • Inclusivity. We think the strongest teams encourage everyone to participate, regardless of their background or previous experience. In 2018, we changed our interview process to get rid of live coding, added real examples from Nurx so you can decide if the work we do interests you, and started interviewing for mentoring and debugging skills. In 2019, we hired our first distributed team (iOS), and launched our second engineering office in Boulder, Colorado, so you can join us even if you can’t move to San Francisco. Our goal is to build teams that can always connect to our patients and their challenges.
    • Data-driven. “Facts are stubborn things; and whatever may be our wishes, our inclinations, or the dictates of our passions, they cannot alter the state of facts and evidence.” - John Adams. As engineers, our job is to ensure everyone has the right data to do their job. Patients need data about how to safely take their medications, doctors need data about a patient’s health profile, and our leaders need data about where our service is (and isn’t) working well. The software we write is central to every aspect of our patient experience and we believe it’s our job to observe and record what happens, then to make that data available to everyone in the company.
    • Humble. We all have something to learn, and something we can teach. However it’s impossible to learn if you aren’t willing to listen or you don’t believe that someone else can teach you something. We strive to break from the historical engineering mold of strong opinions strongly held, and be a place where people are free to experiment and unafraid of being wrong, where we admit when we don’t know the answer and are willing to help others along the way. It’s key to how we dare to be better.

  • How does Nurx interview engineers?

    Engineering interviews can be notoriously challenging, full of questions entirely unrelated to what you’ll do every day, and high-pressure, asking you to write code on a whiteboard and without the help of the tools we regularly use. In some cases, this style of interview results in bias interviews against people from non-traditional backgrounds (e.g. people who don’t know red-black trees).

    Our interview is designed to be different, by giving you a choice in how you show us your technical skills, and focuses on more than just writing code. We want to see how you design systems, debug an issue in an application, and mentor others, as well as how you create software.

    Most of our loops are three steps: a phone screen with a manager, a technical screen with a future colleague, and an onsite interview with your peers. Our goal is to discover what you’re great at.

    We also want you to learn about what we do at Nurx. Every question, from coding to design, is an example of a real problem we solve here. We encourage people to ask questions about these problems, and above all, let us know if they’re something that interests you.

    The hard part is trying to fit this into a reasonable amount of time, as we respect that grueling interview processes with a half-dozen rounds are both exhausting and conflict with other commitments — jobs, family, and free time. Our goal is to fit the entire process into 10-12 hours, including interviews, at-home work, and debrief calls. It’s a big investment, but one we think compares favorably within the industry and works with a variety of life situations.

    Engineering Interview Process
    1. Recruiting Phone Screen
    2. Hiring Manager Phone Screen
    3. Take Home Exercise + Solution Debrief Call
    4. Onsite Interview + Take Home Exercise 2*

    • Architecture/Design - algorithm and systems design (white-boarding)
    • Code Review* - discuss Take Home Exercise 2 solution in-person
    • Debugging - combination of debugging or knowledge deep dive
    • Mentoring - review of our team's code or tech talk (if senior)
    • Product - partnering w/ product
    • Culture/Leadership - 1:1 w/ the hiring manager
    • Candidate Debrief - candidate provides feedback on interview process + candidate experience


    5. Offer + Reference Check

    Our hope is that everyone who interviews with us leaves excited about what we do and where we’re going, and has been treated with respect.

  • Where are you hiring?

    It depends on the team you’re interested in. Here’s a quick summary of our engineering offices:

    San Francisco, CA: Patient Experience, Pharmacy Platform, Provider Tools
    Boulder, CO: Machine Learning and Research Science, Provider Tools
    Anywhere (distributed): Mobile (Android, iOS), Infrastructure/DevOps, and Security

  • Are you hiring remote positions?

    We believe the decision to be remote (or add remote folks) must be made by each team. Some teams have chosen to stay office-based in a specific location, and so are not open to remote positions. Other teams are already distributed, or are working to become more distributed. Each position will clearly note its location and whether it’s open to remote.

    If you join a team that’s office based, we still allow (and encourage) people to work remotely for short periods of time.

    Fully remote employees are also expected to join us in our SF office each year (and we’ll pay for travel). We use those weeks as a way to do in-person team building and detailed design sessions, as well as to meet fellow Nurx teammates.

How do our platforms work?

Step 1

Patients

Our patients request a medical consult or ask questions through our native apps (iOS and Android), web app, text message or phone. The Patient Experience team builds the apps patients use to chat with our service and medical teams. That includes our web, iOS and Android apps, as well as everything patients need to manage an active prescription.

Step 2

Customer & Medical Service

Our customer service team answers non-medical questions and checks patients' IDs, while our medical team reviews consult requests. The Medical Platform team builds the tools that help our doctors, nurses and customer service team deliver high quality care. Our newest team, Machine Learning, speeds up response times by routing patient questions to the right expert automatically.

Step 3

Pharmacy

If somebody is paying with insurance, our software checks their eligibility and prices, and helps pharmacists at our pharmacy or one of our partner pharmacies dispense and ship the order. The Pharmacy Platform team builds the software that determines which pharmacy can best fill each order, as well as the software that runs in our pharmacy and helps us ship medication quickly and at a lower cost than anyone else.

meet the team

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At Nurx, we get the opportunity to make a positive impact on people's lives. Every day my team and I get to work on projects that help improve access to and lower the costs of healthcare. That goal gets me excited to come to work and tackle these problems.
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Working at Nurx has been such a blast! I was initially drawn to it because birth control is something I use every day, and I've had *many* headaches trying to get it over the years. Working for a company that can ease the burden of that process for thousands of people has been awesome. 😃
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Nurx gives me the opportunity to do work that really matters - improving access to healthcare across the country. Tech is overrun with companies that claim to make the world a better place. It's nice to work at a place where that's more than a marketing slogan.

Engineering Roadmap

At Nurx our central goal as technologists and engineers is to discover ways that software can make healthcare safer, faster, and more efficient. We work to augment the experience of our medical team with leading-edge product and industrial engineering skills to eliminate the sources of error, and automatically detect abnormalities or unusual decisions so our medical team can review.

In parallel, we try to move faster by automating or eliminating the wasteful steps in our current healthcare system - like answering questions multiple times, calling to schedule appointments, and faxing paperwork between doctors, just for starters. Our goal is to make the process as seamless and real time as possible, but a lot of work lies ahead before we achieve this vision.

Of course we can’t publish our entire roadmap online. However, we’ve picked a few projects from our 2019 plans that will help you understand the scope and depth of what we’re tackling.

Automated Document Verification

When patients upload photos of their ID and insurance cards the images are verified offline, using a combination of OCR and manual review. In some cases patients have to wait a day to know their insurance card isn’t readable or that they photographed the wrong card. Our goal is to make this process take less than 60 seconds to capture up to 3 different forms of ID and insurance information. We’ll compare data from patients’ IDs to the data on their insurance cards and automatically ask them to fix things like transcription errors and invalid cards, as well as populate information like name and address, all on-device.

Image illustrating 'Automated Document Verification'

Pharmacy Software

We’re replacing retail pharmacy systems with one designed to automate processes like verifying prescription, pricing, and payment details. This will free up our pharmacists to focus entirely on ensuring that a medication is safe for the patient, and that orders are filled correctly and delivered quickly.

Image illustrating 'Pharmacy Software'

Order Optimization

We need to ensure our thousands of patients always have enough medication on hand, without stocking unlimited medication. So we partner with a network of pharmacies, but no two pharmacies are alike: They have different prices and lead times, can only ship to certain states, or don't work with specific insurance plans. Picking the right one is critical to ensuring our patients get their medication at the right time. Our Platform team is building software to handle all of this work automatically, ensuring that our pharmacies are automatically optimizing for our patient experience while keeping costs low.

Image illustrating 'Order Optimization'

New Services

We’re always focused on helping our patients get the care they need. Today, we’re proud to offer 5 different treatment and testing options, but our goal is to keep expanding. As we move into new areas, it often means we need to collect different health data from the patient, be that pictures, descriptions of symptoms, or results from regularly scheduled lab tests. Our Patient Experience team is working on adding new modalities to our web and mobile apps to make that process faster and easier, so Nurx can expand our services and reach more people.

Image illustrating 'New Services'

Medical Contact Routing

Our patients often have questions, both simple customer-service issues like rescheduling a shipment and complex medical questions about medication side effects. Today these incoming contacts go through a manual review process before being sent to the right team. But why? If a patient texts us about side effects, or specific questions about drug interactions, we should be able to automatically route the contact directly to the right person within seconds. This seemingly small optimization can cut hours off our response times.

Image illustrating 'Medical Contact Routing'

Predictive Pricing

Sticker shock is a major problem in healthcare — doctors rarely can tell you what to expect in terms of prices for prescriptions or tests. Our belief is that you should have both visibility into and control of the price you pay for healthcare. If your lab test will cost $200, and that’s not in your budget, we want both you and your provider to know so you can have a discussion about ways to manage costs. Our Patient Experience team is working on this problem today, combining data from insured patients, our partner pharmacies, and our lab testing companies so that everyone has visibility into what care will cost the patient.

Image illustrating 'Predictive Pricing'

We're on a mission to transform healthcare

We’re reimagining the future of healthcare for patients and medical providers. Join us as we revolutionize primary care – starting with sexual health.

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