Principal Software Engineer

foundationhealthcareers; United States; Remote; USD 180,000 - 240,000; Full time

Benefits offered by this job

Remote-first

Equity compensation

Time-zone overlap with UK team

Job summary

foundationhealthcareers is seeking a Principal Software Engineer to shape architecture for a production AI platform used in major US health systems. The role combines deep technical ownership with engineering leadership, focusing on patient-facing AI and seamless EHR integration.

The position is remote-first across the United States, with periodic in-person time at an engineering hub and timezone overlap with UK teams. Equity is offered for an early-stage contributor role.

Qualifications

• Deep hands-on experience building large-scale systems.
• Staff-level or equivalent with production-use architecture decisions.
• Experience with LLMs beyond SDK calls, including agents and evaluations.
• Bias toward simple, well-structured systems.
• Experience in environments with strict regulatory or compliance needs.
• Proven track record solving high-impact problems.

Responsibilities

• Own end-to-end architecture across several product areas.
• Build and harden agentic AI for patient interactions (voice/SMS).
• Lead EHR integration work for queuing, automation, and 340B compliance.
• Drive platform expansion across health systems; lead migration efforts.
• Shape engineering with AI, including model selection and cost/latency tradeoffs.
• Mentor engineers and improve cross-team development practices.

Skills

Architecture design

LLMs and agents

Production systems

Healthcare compliance

Tools

LLM tooling

Guardrails & red teaming

Job description

Role overview

A Principal Software Engineer role responsible for shaping architecture across multiple product areas of a production AI platform deployed inside major US health systems to streamline pharmacy operations. The platform handles real patient communication over voice and SMS and integrates directly with electronic health record workflows, where failures carry direct clinical consequences for patients. This is a senior, hands-on position that pairs deep technical ownership with engineering leadership across the organization.

Responsibilities

• Own end-to-end architecture across several product areas, designing systems capable of scaling 10-100x without a rewrite
• Build and harden agentic AI for patient-facing interactions, including voice and SMS agents, plus the evaluations, guardrails, red teaming, and pharmacist-oversight design that make them trustworthy
• Lead deep EHR integration work covering queueing, prior authorization automation, and 340B compliance
• Drive the platform's expansion from a handful of health systems to hundreds, building the first mile of the migration yourself
• Shape how engineering builds with AI, including model selection, context management, cost and latency tradeoffs, and evaluation methodology
• Mentor engineers, run cross-team initiatives, and improve development practices, including agentic developer workflows

Requirements

• Recent hands-on experience building serious systems, with the ability to go deep on any shipped detail
• Prior Staff-level or equivalent experience at an organization with a high technical bar, with architectural decisions still in production use
• Production experience building with LLMs beyond SDK calls, including agents, tool use, evaluations, and guardrails
• A bias toward simplicity, favoring well-structured systems over prematurely distributed ones
• Background in environments where mistakes are expensive, such as healthcare, fintech, fraud, trust and safety, or other compliance-driven domains
• Track record of independently identifying and solving the most impactful problems

Nice to have

• Production experience with AI safety, LLM security, or red teaming
• Experience rolling out agentic development practices at a team or company level, with measurable impact on output and quality

Benefits and work setup

• Remote-first across the United States, with periodic in-person time at an engineering hub
• Preference for Eastern or Central time zones to support overlap with a UK-based engineering team
• Equity sized for an early-stage contributor role