Company Overview: 

Designed for beauty, built for growth, PatientNow brings clinical-grade EMR with intuitive charting, smart AI automation, advanced photography, marketing, patient engagement, and seamless practice management into one elegant system. Everything works together naturally, helping clients create a smooth, intentional patient experience from consultation to checkout. Supported by a U.S.-based team that understands the pace and artistry of aesthetics, PatientNow provides the technology and partnership to scale with confidence.

This role will focus on the Recura product line, a newly integrated part of PatientNow.

Vision: Empowering practices and businesses to improve health and wellness worldwide by helping their clients look and feel their best.

Mission: PatientNow is elevating businesses focused on beauty, wellness and medical aesthetics with innovative, all-in-one software and consulting service solutions. People who partner with us stand out in the industry with strong market differentiation, while streamlining operations for long term success and sustainable growth.

Values:

• Show up – being present and supportive: for each other through collaboration and respect, for our customers with exceptional service, and for the business with dedication to excellence and growth.
• Own the outcome – By understanding the objective, exceeding expectations with pride, confirming resolution, communicating early and often, and continuously learning and improving
• Be Authentic – By sharing thoughts and opinions, keeping promises, showing your true self, and engaging with respect

Position Summary:

The Senior Telephony Infrastructure Engineer owns Recura’s real-time communications layer, including voice calling, call routing, and A2P messaging infrastructure. This role is responsible for building and operating deterministic, observable, and compliant telephony systems that behave correctly under carrier retries, partial failures, and real-world edge cases.

This is a senior individual contributor role with mentorship expectations. You will design call routing, missed-call detection, and messaging compliance systems that downstream product teams depend on, while insulating them from carrier complexity and failure modes.

Essential Duties and Responsibilities:

• Design, implement, and operate SIP-based voice infrastructure and WebRTC calling.
• Build and maintain call routing systems including schedules, ring groups, IVR, voicemail, and overflow logic.
• Design timezone-aware, rules-based routing, including overnight ranges and day-of-week matching.
• Implement missed-call, abandoned-call, and after-hours detection with deterministic, idempotent event emission.
• Own SMS/MMS carrier integrations, including A2P 10DLC registration workflows and enforcement.
• Build and maintain ISV-style subaccount onboarding, including phone number provisioning and messaging service assignment.
• Implement answering machine detection (AMD) with async callbacks and configurable detection behavior.
• Design VoIP observability systems for call session tracking, event correlation, and production debugging.
• Handle phone number lifecycle operations, including migration between messaging services with rollback safety.
• Mentor engineers on reliability, event-driven design, and debugging complex production systems.

Competencies: To perform the job successfully, an individual should demonstrate the following.

• Adaptability - Demonstrates persistence and overcomes obstacles. Measures self against standard of excellence. Recognizes and acts on opportunities. Sets and achieves challenging goals. Takes calculated risks to accomplish goals.
• Business Ethics – Inspires the trust of others. Keeps commitments. Treats people with respect. Upholds organizational values. Works with integrity and ethically.
• Communications - Exhibits good listening and comprehension. Expresses ideas and thoughts in written form. Expresses ideas and thoughts verbally. Keeps others adequately informed. Selects and uses appropriate communication methods.
• Continuous Learning - Assesses own strengths and weaknesses. Pursues training and development opportunities. Seeks feedback to improve performance. Shares expertise with others. Strives to continuously build knowledge and skills.
• Problem Solving - Develops alternative solutions. Gathers and analyzes information skillfully. Identifies problems in a timely manner. Resolves problems in early stages. Works well in group problem solving situations.
• Teamwork - Balances team and individual responsibilities. Contributes to building a positive team spirit. Exhibits objectivity and openness to others' views. Gives and welcomes feedback. Puts success of team above own interests.

Education/Experience:

• 5+ years of experience building or operating telephony, VoIP, or CPaaS systems.
• Hands-on experience with SIP-based calling and WebRTC in production environments.
• Experience building call routing systems (schedules, ring groups, IVR, overflow logic).
• Experience implementing A2P 10DLC compliance workflows, including brand/campaign lifecycle handling.
• Experience with ISV or multi-tenant CPaaS models, including subaccount provisioning.
• Strong understanding of event-driven systems, webhook retries, and idempotent processing.
• Familiarity with result-based error handling patterns (explicit success/failure states over exceptions).
• Prior startup experience (required).
• Familiarity with modern backend systems (e.g., TypeScript, Postgres) and cloud infrastructure, preferred.
  
  

Why You’ll Thrive Here:

In this role, you’ll get to: 

• Work at the intersection of innovation and impact, helping real-world practices grow and thrive in a rapidly expanding market;
• Collaborate with a talented, curious team that values experimentation, learning, and customer empathy;
• Be empowered to lead with autonomy while supported by strong leadership and product discipline; and
• Help modernize aesthetics software in an industry that’s ripe for transformation through innovative, AI-native technology.

Supervisory Responsibilities: This position does not have direct people management responsibilities but is expected to mentor and guide other engineers.

Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to sit at a desk and work on a computer for prolonged periods.

The above job description is not intended to be an all-inclusive list of duties and standards of the position. Incumbents will follow any other instructions, and perform any other related duties, as assigned by their supervisor.

Note: PatientNow jobs are listed on our careers page patientnow.com/careers and select job boards. We will never ask for payment or sensitive info. Official emails come from @patientnow.com or mail@ats.rippling.com