Principal Software Engineer

• Agentic AI that’s safe to put in front of patients. This covers voice and SMS agents, plus the evals, guardrails, red teaming and pharmacist-oversight design that make them trustworthy. If you’ve worked on AI safety or LLM security in production, this is where that experience pays off.
• Deep EHR integration. Epic queues, prior authorization automation and 340B compliance, where correctness really matters and the specs are older than some of our engineers.
• Our target-state architecture. You’ll take the platform from a handful of health systems to hundreds and build the first mile of that migration yourself.
• How we do AI engineering. That includes model selection, context management, cost and latency tradeoffs, and evaluation methodology.

Who tends to do well here

• You’ve built serious systems with your own hands recently, and you can go deep on the details of anything you’ve shipped. Your title doesn’t matter much. Plenty of great Principals have spent time as directors or heads of something without ever stopping building.
• You’ve worked at Staff+ level somewhere with a high bar, and you can point to architectural decisions a company still runs on.
• You’ve built with LLMs in production, well beyond SDK calls: agents, tool use, evals, guardrails, and the unglamorous work of making them reliable.
• You keep things as simple as the problem allows. You’d sooner run a well-structured monolith on Postgres than ten microservices nobody can debug, and you change the architecture when real constraints show up, not before.
• You’ve worked somewhere mistakes are expensive. That could be healthcare, but fintech, fraud, trust and safety, or anywhere compliance shapes design counts too. We don’t need you to know healthcare yet. We need you to care about getting it right.
• You find the highest-leverage problem in the company and solve it without waiting to be pointed at it.