Signal EHR is the clinical-intelligence and practice-management platform for licensed therapists in the US and Canada. We are distributed, async-first, and deliberately small — we hire when a specific gap is causing real pain, and not before. If you are exceptional at one of the disciplines below, we want to hear from you whether or not the role is open today.
No portals, no recruiters in the loop. A real human reads every email and writes back within five business days.
What we believe
These are not values posters. They are how we decide what to ship, what to refuse, and what to fix when something has gone sideways.
Belief 01
Every feature is judged on one question — does it give a therapist back a minute of their evening? If it does not measurably reduce time-on-keyboard, time-to-paid-claim, or time-to-signed-note, it does not ship. We are not in the business of dashboards for their own sake.
Belief 02
Zero raw audio storage. AES-256 in transit and at rest. Audit logs on every PHI access. Consent surfaced before capture, never buried in settings. HIPAA and PIPEDA are the floor — the people across from a therapist trusted them with the worst week of their life, and that trust is ours to carry too.
Belief 03
Insurance reconciliation. Calendar conflict resolution. Intake form parsing. The unglamorous middle of a practice is where software earns or loses trust. We finish the boring work — properly, with tests — before touching the demo-ready surface. Surviving a Tuesday at 4pm in a busy clinic is the bar.
How we work
We are deliberately small and deliberately distributed. The ergonomics of the team are the ergonomics of the product — thoughtful, considered, and done in deep blocks of focused work rather than a steady churn of interruptions.
If you have spent the last few years trying to do good work between standups, pings, and a calendar that ate your week, this is the kind of place that was built for you.
Distributed, async-first.
We work across time zones from wherever home is. Decisions live in writing — short docs, threaded discussions, recorded looms — so the team in Toronto isn't waiting on someone in Lisbon to wake up. Synchronous time is reserved for the calls that actually need a face: one-on-ones, design reviews, and the occasional gnarly architecture debate.
Small team, deep ownership.
You will own the thing you ship — the spec, the code, the rollout, the on-call when something breaks at 2am. There is no QA team waiting downstream and no manager triaging your inbox. The trade-off is that we hire slowly and pay you like the senior operator we expect you to be.
One offsite a year. The rest is async.
We get the whole team in one room once a year — a real week together, somewhere worth flying to, with the company covering travel. The other fifty-one weeks are yours to structure: deep-work mornings, school pickups, training runs, whatever fits the life you're trying to lead. We measure outcomes, not hours at a desk.
Roles we're thinking about
We are not actively hiring any of the roles below. We are listing them anyway, because if you are exceptional at one of these disciplines we want to be on your radar — and you on ours — for the moment that changes. Send a short note and a few links to the best work you have shipped.
Engineering · Remote (US / CA / EU)
Own end-to-end features across the stack — Next.js 15 and TypeScript on the frontend, Python and FastAPI on the backend, Firestore underneath. You will ship to production weekly, write the migration plan when schemas change, and sit with clinicians on calls to understand what is actually slow about their day.
Design · Remote (US / CA)
The first design hire. You will own the product surface — every screen a therapist sees during a session, every Amelia conversation, every email a patient receives. Brand work too: marketing site, deck, identity, the way the company sounds. We have an editorial design system to extend, not start from scratch.
Clinical · Part-time, ~5 hrs/week
A licensed therapist (LMFT, LPC, LCSW, PhD/PsyD, or Canadian equivalent) who will sit with us weekly and challenge our assumptions about clinical workflows, note formats, modality fidelity, and crisis-flag thresholds. You keep your practice; we get a clear-eyed clinician in the room.
Research · Remote (US / CA / EU)
Work on the core clinical engine — voice models, diarization, affect estimation, fine-tuned LLMs for documentation in eight clinical formats. You will own model selection, training pipelines, evaluation harnesses, and the careful work of measuring whether a new model actually helps a clinician or just looks better on a benchmark.
How to apply
No portals. No coding gauntlets you have to schedule around your day job. No four-month silences after a phone screen. Send a short note and a few links to the best work you have shipped, and a real person on the team will write back.
careers@signalehr.comWhat to include
What we offer
We compete for senior people, so the package has to be real. Here is what is on the table for full-time hires today.
Meaningful equity.
Real ownership for early hires, with a four-year vest and a one-year cliff. We tell you the share count, the option strike, and the most recent 409A — not coy hand-waving about percentages.
Competitive cash.
Top-of-market for early-stage healthcare software. We benchmark twice a year against Levels.fyi and Pave, and we publish bands internally so nothing depends on how hard you negotiate.
Healthcare (US & Canada).
Full medical, dental, and vision in the US — company pays 100% of premiums for you and a generous share for dependents. Canadian team members get an equivalent stipend for private supplemental coverage on top of provincial care.
Real PTO. The kind people take.
Unlimited PTO with a four-week minimum, tracked. The founders take their four weeks; so does the team. If your manager has not asked when you are taking your next break, that is a bug we want to fix.
Tools and home office.
A new MacBook Pro on day one, a $2,000 home-office stipend in your first month, and an annual $1,500 refresh budget — chair, desk, monitor, headphones, whatever a working setup needs.
Ownership, not theater.
No status meetings for the sake of status meetings. No performance reviews driven by a calendar instead of a need. We expect senior judgment and get out of its way.
If you write to us, we will write back within five business days — even if the answer is “not now” or “not a fit.” That is a promise we have kept since the day the company was founded, and we intend to keep it for as long as we are around.