Engineering and Product Team at Alto

Our mission at Alto is to fulfill medicine’s true purpose—to improve quality of life—for everyone who needs it. We build technology and use empathy to advance the pharmacy into the modern era and make high-quality healthcare accessible to all.

Job Openings at Alto

Top Engineering Values

Each team is asked to select, explain, and rank their top 8 values in order of importance.
  • Customer Comes First

    Enabling a better patient experience is weaved into everything we do at Alto.

    “The customer comes first” is our #1 guiding principle. Everyone at Alto is genuinely passionate about our mission to create the most patient-centric pharmacy in the world. There are 125,000 deaths every year due to patients who do not take their medications properly -- those are 125,000 avoidable deaths. The current system is broken and getting your prescription meds are difficult and confusing: prior authorizations, renewals, high copays for drugs not covered by your insurance, travel to the brick-and-mortar pharmacy, and long lines or closed pharmacies. Alto removes the pain points to create a process that is now simple, friendly, and fully transparent. Given the statistics and adherence rates, Alto has saved an estimated 45 lives and we’re determined to save thousands more. If any of this resonates with you, please let us know. We'd love to hear from you!

  • Actively Practices Inclusion

    We prioritize diversity and inclusion as a small company.

    Alto focuses tremendous energy on diversity and inclusion, both in hiring and our day-to-day practices. An exceptionally talented engineer who nails our interviews won’t make the cut if s/he doesn’t also share and embody our values. We make sure every candidate speaks with at least two female interviewers and when discussing technical challenges with current team members, we strive to create an environment where everyone feels they can speak openly and without fear of judgment. Our company culture of transparency, compassion, and open-dialogue is something we’re set on maintaining as we grow, even in the face of competing hiring goals.

    Atlo values technical expertise and a strong programming skillset, but it’s almost more important that every member on our team embodies humility and compassion too. After all, our patients face the same problems regardless of their race, ethnicity, religion, age, sexual orientation, or gender. As you can imagine, a problem facing a diverse population requires an equally diverse team to solve it. We can’t overstate how highly we prioritize our commitment to inclusivity.

  • Impressive Team Members

    Alto's team is comprised of talented and kind people, backed by the right investors, and advised by experienced board members to tackle a big industry challenge.

    Probabilistically, we are going to fail. It’s the hard, but very real, truth here in Silicon Valley. That’s why Alto wouldn’t have even started unless we positioned ourselves -- to the best of our abilities -- for success. Our investors have expertise in this field. Our engineering team has experience growing startups. Collectively, we’ve learned valuable lessons about what works and of course, from our many mistakes in the past, about what doesn’t. (One of which is putting “growing quickly” second to “growing wisely.")

    Meet our Product Team!


    • Jamie Karraker, CTO/Co-Founder (former Parse/Facebook)
    • Monica Tran, VP of Product (former Product Lead at Khan Academy and Apple)

    Software Engineers:

    • Amir Ghazvinian, Engineer (former CoFounder of Exec & Interstate Analytics - both YC)
    • Damien Kan, Engineer (former CEO of Shogun)
    • Elnaz Mosheghian (former Lob)
    • Alex Toombs, Engineer (former Apcera)
    • Sierra Brown, Engineer (former 23andMe)
    • Le Qi, Engineer (former GE)
    • Tom Cahill, Engineer (former Apcera)
    • Michael Riess, Engineer (former Lumity)
    • Brian McRae, Engineer (former Genentech)
    • Andy Lau, Engineer (former Infer)
    • Trevor Borg, Engineer (former 4C Insights)

    Product Designers:

    • Katie Rinkevich, Product Designer (former Optimizely and Etsy)
    • Jon Saquing, Product Designer (former Optimizely)
    • Omar Jalalzada, Product Designer (former Coatue Management)

    Product Managers:

    • Jeremy Kent, Product Manager (former Postmates and Watsi)
  • Engages with Community

    We share a common desire to make a tangible impact on real people.

    There are over a million ways to make an impact on someone, and no way is better or more meaningful than the other. At Alto, we have an overarching desire to “help the world,” and tackle an outrageously high medication non-adherence rate (the rate at which people don’t take their medication properly, or at all). However, we are largely motivated and inspired by connecting with the individuals we’re trying to help. That’s why we take so much pride in our Yelp reviews, have a Slack bot that posts every survey response we get from a patient, and why once a month, we volunteer at the SF Marin Food Bank. We want to be in touch with and give back to our community, personally and face-to-face. This is the common denominator across all members at Alto; we bond with one another as a result of bonding with our community, even when that means repackaging 3,000 pounds of cashews at the Food Bank.

  • Start-to-Finish Ownership

    An Alto Engineer built our entire patient dashboard from scratch in 3 months.

    Another Engineer built our prior authorization system that touches all facets of our platform from our admin tools system, the patient dashboard, the app, to the provider dashboard. These are examples of the depth and breadth of projects that our engineers take on, and what you can expect for yourselves when you join. In terms of ideation, we project plan as an entire engineering team so everyone has a say on what they work on. Additionally, engineers are expected to spend time doing research and shadowing during the initial phases of their projects in order to help set project goals, influence design, and plan the project timeline. We have a clear mission at hand, with defined short and long-term goals. If you are looking for an opportunity to own a significant project that you can call yours, now is the right time to join our team.

  • Cross-Department Collaboration

    We’re constantly talking with each other because Alto's solution depends on collaboration.

    Once a week, we have a "Tea Time" meeting to review recent incident reports from our patients. This meeting always includes members from pharmacy, patient care, pharmacy operations, engineering, and design because we believe in a cross-functional approach to resolve the underlying issue(s) for any unhappy patient. Together, we figure out why these problems happened and what we can do to prevent them in the future.

    The problem Alto is solving is so complex that it requires the skillsets of a very broad team. Engineers need to work with pharmacists, designers need to work with our operations team, and the people who manage our partnerships with physicians and insurance providers need to be on the same page too. Engineers, pharmacists, and operations sit together, lunch together, and we’re constantly talking.

  • Fast-Paced Environment

    Scrappiness and urgency are two of our company values.

    Our team members have had previous experiences working at or founding startups, so we’re well aware that “fast-paced environment” has become a euphemism for “it’s crazy." Yes, the excitement and energy that make startup culture so special is certainly alive and well at Alto, but what we really mean by fast-paced is that you will be expected to contribute a lot and very quickly. We’ve built different products in a very short time with very few people, and we’re constantly pushing to ship new things. Alto thinks on the order of weeks, not months. As we grow our team, we’re looking for people who are energized by a sense of scrappiness and urgency.

  • Rapidly Growing Team

    We're growing!

    It’s been an exciting 2+ years so far! In the summer of 2017, we rebranded and raised our Series B, which has put a number of projects in motion, and we need help to do it all. As a new Alto Engineer, you can help us expand to beyond SoCal and build our systems that will support multiple locations. If you’re a mobile developer, you can build our mobile app from scratch in React native, making our customers’ on-the-go experience seamless. Finally, we will be making a number of changes and additions to our Fertility product. Whether you enjoy frontend, backend, or fullstack work, you can help us take a holistic look at the Fertility patient experience and build any feature(s) that improve it, including changes to internal tools, the patient app, or the provider dashboard. If you’re curious about who we are, where we’re going, or how you might fit into our Pharmaly, feel free to reach out!


  • Customer Comes First
  • Actively Practices Inclusion
  • Impressive Team Members
  • Engages with Community
  • Start-to-Finish Ownership
  • Cross-Department Collaboration
  • Fast-Paced Environment
  • Rapidly Growing Team

Company Properties

  • B2C
  • Technical Founder(s)

Team Members

  • 1 Analytics Manager
  • 1 CTO
  • 3 Product Designers
  • 1 Product Manager
  • 11 Software Engineers
  • 1 VP of Product

Vacation Policy

15-20 paid time off days + 10 national holidays off + sick days

Tech Stack

React Native, React, Ruby on Rails, Go

Interview Process

(1) Intro phone screen with short coding challenge. (2) Remote coding assignment. (3) Onsite. (4) Offer.