Staff Software Engineer

Foundation Health; Oregon; Hybrid; USD 150,000 - 230,000; Full time

Benefits offered by this job

Equity grant

Remote-first

Job summary

Foundation Health is building an AI operating system for pharmacies. We seek a Staff Engineer to own the prior auth pipelines, Epic integrations, and AI agents that handle patient calls and texts. You’ll shape architecture, write substantial code, and set the standard for the team while aligning with the broader platform.

This remote-first role is based in US Eastern or Central time. You’ll join a startup-sized team building impactful tooling with meaningful equity as the company scales.

Qualifications

• Experience owning a product and shaping its direction.
• Track record building complex systems from scratch.
• Hands-on by default, with ability to zoom out when needed.
• High agency; you don’t wait for a perfect ticket.
• Comfort with ambiguity in fast-moving environments.
• Daily use of AI tools (Claude/Cursor-native) and pushing them further.

Responsibilities

• Own production agentic systems in a regulated space, including automated workflows and AI features.
• Design system across the product, including Epic integration and patient communications infrastructure.
• Set coding standards, patterns, and review culture within the team.
• Deliver across the workstream with roadmaps tied to milestones and cross-team dependencies.

Skills

Hands-on engineering

Systems design

AI tooling (Claude/Cursor)

Delivery under ambiguity

Tools

Epic integration

LLM-assisted QA

RAG and function calling

Job description

About Foundation Health

Foundation Health is an AI operating system for pharmacy - built by a team who lived the problem firsthand, not one that came to healthcare from the outside. Every day, prior authorizations delay prescriptions, pharmacists lose hours to paperwork instead of patients, and prescriptions slip through the cracks between health systems. We believe thoughtfully applied AI can finally change that - deep, integrated infrastructure that streamlines how care is coordinated, purpose-built for the complexity of specialty pharmacy. We're building toward a world where pharmacy teams spend their time on patients, not paperwork - where AI handles the routine so clinicians can focus on what only humans can do. Getting there takes the right people. We're looking for curious, ambitious folks who want to help solve healthcare's hardest problems - for our patients, our partners, and each other.

The Role

We've built an AI operating system for pharmacies. It handles the operational work behind paperwork, prior auths and care coordination. It's live with enterprise health systems across the US, and we're working directly with one of the biggest names in pharmacy.

As a Staff Engineer, you'll own one of our core products: the prior auth pipelines, the Epic integrations, and the AI agents that handle patient calls and texts. You'll make the architectural calls, write a lot of the code yourself, and set the standard for everyone else working on it. Most days you're deep in the code. But you're also the person who can step back, see how the product fits with the systems around it, and spot the problem coming before it lands.

Maybe you're somewhere big, where the systems are impressive but the ownership is glacial. Maybe you're at a startup that's stopped being one. Either way, the itch is the same. Here the loop is: see the problem, build it, watch a pharmacist use it that week.

What you'd own

• Production agentic systems in a regulated space. That covers automated workflows, LLM-assisted QA, and AI features like RAG, function calling and evals. The output touches real patient care, so "it mostly works" isn't the bar.
• System design across your product. That spans the Epic integration, the prior auth pipelines and the patient comms infrastructure, with an eye on how it all connects to the rest of the platform.
• The standards on your team. You set the patterns, the review culture and the quality bar, mostly through your own code. Your PRs should be the ones people learn from.
• Delivery across your workstream. That means roadmaps tied to product milestones, cross-team dependencies, and shipping software that solves the user's problem, not just software that passes tests.

What we're looking for

• You've owned a product before and made the calls that shaped it. You felt it when it broke.
• A track record of building complex systems from scratch, and you can talk us through the specific decisions you made and why.
• You're hands-on by default, and you can zoom out when the situation needs it.
• High agency. You don't wait for a perfectly scoped ticket. You work out what needs to happen and do it.
• Comfort with ambiguity, because things move fast and change often.
• You use AI tools daily (we're Claude/Cursor-native across the team) and you want to push that further.

Where you'll work

This role is remote-first, but you need to be based in US Eastern or Central time. Our customers, our pharmacy partners and a lot of the team sit there, and you can't really own a product from six hours out of sync. If you're near Orlando, we've got an engineering hub downtown you're welcome to use.

There's no legacy estate to babysit, no change board and no three-week sign-off loop.

The upside

We're a Series A company of about 70 people, and roughly 40 of them are engineers. At that size, a Staff hire shapes how the product turns out. The equity reflects that: this is a meaningful grant at an early stage, not a rounding error. If this works, you'll have built a core part of it, and you'll own a real piece of it.

We're backed by Define Ventures and led by a 2x founder. Our VP of Engineering came from DeepMind.