Principal Software Engineer

New
F
Foundation HealthHealthcare AI
United States - Remote; remote-first across the US, Ideally Eastern or Central time.Full-TimePrincipal
Salary not disclosed
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Job Details

Required Skills
PostgreSQL

Requirements

  • Have worked at Staff+ level in a high-bar environment.
  • Bring recent hands-on experience building serious systems and the ability to discuss shipped work in depth.
  • Have made architectural decisions that a company still runs on.
  • Have built with LLMs in production beyond SDK calls, including agents, tool use, evaluations, and guardrails.
  • Have experience making production AI systems reliable.
  • Have worked in an environment where mistakes are expensive, such as healthcare, fintech, fraud, or trust and safety.
  • Be able to identify and solve high-leverage problems independently.
  • Be willing to keep systems as simple as the problem allows and change architecture in response to real constraints.

Responsibilities

  • Own architecture across several product areas and design systems that can grow 10–100x without a rewrite.
  • Build first versions of the company’s hardest technical solutions.
  • Develop safe voice and SMS agents, including evaluations, guardrails, red teaming, and pharmacist-oversight design.
  • Build deep EHR integrations, including Epic queues, prior authorization automation, and 340B compliance.
  • Build the first mile of the platform’s migration from a handful of health systems to hundreds.
  • Shape AI engineering practices, including model selection, context management, cost and latency tradeoffs, and evaluation methodology.
  • Mentor engineers and lead projects across teams.
  • Improve how engineering uses AI to ship faster without reducing quality.
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