Senior AI Engineer Clinical Reasoning

NxT Level; New York (NY); Hybrid; USD 180,000 - 260,000; Full time

Job summary

NxT Level is hiring a Senior AI Engineer to help build the next generation of clinical AI systems in a hybrid New York setting. You will design agentic reasoning, retrieval, and evaluation components and ship production-ready AI solutions that assist clinical decision making.

The role blends research with engineering, requiring hands-on work beyond notebooks and a passion for safe, trustworthy AI in healthcare.

Qualifications

• Advanced degree in a quantitative field with applied AI/ML experience.
• 7+ years of relevant experience building and researching ML systems.
• Recent hands-on work with LLMs, agentic systems, or production AI infrastructure.

Responsibilities

• Design and build agentic clinical reasoning systems.
• Develop architectures that support reasoning, reflection, verification, tool use, routing, uncertainty handling, and escalation.
• Build systems where specialized agents and models work together for safe clinical decisions.
• Create evaluation platforms, rubrics, simulations, and experiments to measure AI performance in clinical use cases.
• Identify whether improvements should come from reasoning, retrieval, model behavior, data, or engineering changes.
• Apply methods such as fine-tuning, distillation, reinforcement learning, and prompt/system optimization.
• Build training data, feedback, reward, and experimentation pipelines.
• Develop search, ranking, retrieval, and grounding algorithms tied to medical evidence and patient context.
• Improve retrieval systems based on impact on downstream clinical decisions.
• Own problems end-to-end from framing and experimentation through shipping and measurement.
• Collaborate with engineering, clinical, product, and physician-scientist partners.

Skills

Agentic architectures

Model evaluation

Model training

Search & retrieval

Engineering to production

Education

Advanced degree (quantitative)

7+ years ML experience

Hands-on with LLMs / agentic systems

Job description

Senior AI Engineer

Location: New York City
Work Style: Hybrid Onsite
Employment Type: Full-time
Focus: AI, LLMs, Clinical Reasoning, Evaluation, Retrieval, Applied ML

About Our Client

Our client is building AI technology with the mission of making high-quality healthcare more accessible, affordable, and scalable.

Their AI-powered clinical platform already supports millions of patient consultations, and the company is working toward scaling that impact significantly while continuing to improve clinical safety, reasoning quality, accuracy, and trust.

This is an opportunity to join a team building real-world clinical AI systems used by patients every day. The company operates in a live healthcare environment, giving the team a unique dataset and feedback loop to test, improve, and deploy AI systems in practical clinical care.

About the Role

Our client is hiring a Senior AI Engineer to help build the next generation of clinical AI systems.

This role blends research and engineering. The ideal candidate is not just running experiments or writing notebooks — they are building real systems that reason, retrieve evidence, evaluate performance, and improve over time.

You’ll work on agentic reasoning, retrieval, evaluation infrastructure, model learning, and clinical decision support systems. The goal is to help every component of the AI platform become safer, more accurate, more useful, and more trustworthy with each iteration.

What You’ll Do

• Design and build agentic clinical reasoning systems

• Develop AI architectures that support reasoning, reflection, verification, tool use, routing, uncertainty handling, and escalation

• Build systems where specialized agents and models work together to support safe and reliable clinical decisions

• Create evaluation platforms, rubrics, simulations, and experiments to measure AI performance in clinical use cases

• Identify whether improvements should come from reasoning, retrieval, model behavior, data, or engineering changes

• Apply methods such as fine-tuning, distillation, reinforcement learning, preference optimization, and prompt or system optimization

• Build training data, feedback, reward, and experimentation pipelines

• Develop search, ranking, retrieval, and grounding algorithms tied to trusted medical evidence and patient context

• Improve retrieval systems based on their impact on downstream clinical decisions, not just document relevance

• Own problems end-to-end, from framing and experimentation through shipping and measurement

• Collaborate closely with engineering, clinical, product, and physician-scientist partners

What We’re Looking For

• Strong experience building real AI, ML, or LLM-powered systems

• Deep experience in at least two of the following areas:

  • Agentic architectures, reasoning systems, and tool use

  • Model evaluation, experimentation, and rubric design

  • Model training, fine-tuning, distillation, or reinforcement learning

  • Search, ranking, retrieval, RAG, or grounding systems

• Strong ML fundamentals, including training data, objectives, metrics, failure analysis, calibration, and validation

• Ability to work in complex domains where ground truth is incomplete and expert opinions may differ

• Strong engineering fundamentals with experience building production systems, not just research prototypes

• Clear communication and strong collaboration across engineering, clinical, and product teams

• Ability to think through business impact and prioritize technical work accordingly

• Comfort operating with autonomy in a builder-first environment

Experience Profile

Successful candidates will typically have one of the following backgrounds:

• Advanced degree in a quantitative, computational, scientific, or related discipline with 3+ years of highly relevant applied AI/ML or research experience

• 7+ years of relevant experience building and researching ML systems

• Recent hands-on work with LLMs, generative AI, agentic systems, retrieval systems, or production AI infrastructure

Our client cares more about the depth and quality of your work than a specific credential or traditional career path.

Bonus Experience

• Published research, patents, meaningful open-source contributions, or novel production ML systems

• Experience building AI systems at an early-stage or high-growth company

• Experience in healthcare, clinical AI, regulated industries, or safety-critical environments

• Familiarity with clinical workflows, healthcare data, HIPAA, FHIR, EHR systems, or HL7

• Experience with human-feedback systems, RLHF, simulations, or synthetic data generation

• Experience with AI safety, bias detection, calibration, fairness, or model reliability

Why This Opportunity

• Build AI systems that can meaningfully improve access to healthcare

• Work on real clinical AI problems with real patient usage and feedback

• Join a team focused on reasoning, retrieval, evaluation, safety, and trust

• Work side by side with physician-scientists and experienced technical builders

• Own high-impact AI systems end-to-end

• Operate with autonomy in a fast-moving, builder-first environment

• Contribute to technology designed to scale from millions of consultations to much larger clinical impact

Compensation & Benefits

• Competitive salary

• Meaningful equity with upside as the company grows

• Comprehensive health benefits

• High autonomy and ownership over important technical problems

• Opportunity to build AI systems transforming healthcare at scale

Ideal Candidate Profile

The ideal candidate is a research-minded AI engineer who wants to build intelligent systems that work in the real world. They care deeply about reasoning quality, evaluation, safety, and measurable improvement — and they have the engineering ability to turn ambitious ideas into production systems.

This person is excited by the challenge of building clinical AI that can earn trust over time.