Foundation Health

Own architecture across product areas, mentor engineering teams, and lead development of safe, scalable AI agents for healthcare workflows. | Requires 10+ years of experience, Staff+ architectural leadership, production LLM and agentic workflow expertise, and experience building high-stakes systems. | 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 This isn’t a pitch deck. Our platform is live in production inside major US health systems. Our AI handles real patient communication over voice and SMS and plugs directly into Epic workflows. If it gets something wrong, there’s no funny screenshot: a real person doesn’t get their medication. That’s the standard we build to. You’ll own architecture across several product areas and design systems that can grow 10–100x without a rewrite. When the hardest problem in the company comes up, you’re the one who opens the editor and builds the first version. You’ll also make the rest of engineering better. That means mentoring, leading projects across teams, and changing how we build, including how we use AI to ship faster without shipping worse. If you’ve already rolled out agentic dev practices at a team or company level and can show what happened to output and quality, we’d love to hear about it. You’ll work directly with our VP of Engineering (ex-DeepMind) and CEO. Nobody here manages from a distance, at any level, and that includes the Principal. The problems you’d own 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. Where we are We’re about 70 people, past product-market fit, raised a $20M Series A led by Define Ventures, and our CEO is a 2x founder. The practical stuff We’re remote-first across the US, with an engineering hub in downtown Orlando that you’d visit from time to time. We’d ideally like you on Eastern or Central time, since a good chunk of our engineering team is in the UK and the overlap really helps. And it’s early enough that the equity is founding-role equity, not a rounding error.

Develop and maintain software features with a focus on APIs, data modeling, and system health monitoring. | Experience shipping production systems and ability to work with loose requirements in fast-paced environments. | 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, tackling the operational infrastructure behind things like paperwork and care coordination. It's in production with enterprise health systems across the US, and we're working directly with one of the biggest names in pharmacy. As a Senior Engineer, you'll take features from a loose requirement all the way to production. That covers the data model, the APIs, the LLM layer, the rollout and the monitoring afterwards. You'll work on prior auth logic, Epic workflows and AI agents that talk to patients, and things ship fast, sometimes within 48 hours of the idea. There's no ticket factory and no layers of sign-off. The technical problems you'd own Features built on LLMs that ship to real users in a regulated environment. That means evals, guardrails and thinking hard about failure modes, not demo-ware Integration with the messy, fascinating reality of healthcare systems: Epic workflows, prior auth logic and pharmacy operations Full-feature architecture covering data models, APIs, state and rollout. It's yours, end to end Your own feature area's health. You'll watch metrics, error logs and user feedback because the area is yours, not because someone assigned you a dashboard What we're looking for You've shipped production systems you can talk about in depth: the choices, the tradeoffs, and what you'd do differently You thrive when the path isn't fully paved. Loose requirements energise you rather than block you Genuine product instinct. You ask "why" when a requirement feels off, and you take regressions personally AI tools are already part of how you work, not something you're meaning to try Where you'll work This is a hybrid role, 3 days a week in our downtown Orlando office. That 48-hour turnaround happens because the people who need to agree are in the same room. You can sketch the data model on a whiteboard at 10am and have it in review by the afternoon. Our VP of Engineering works from the same office, everything is greenfield, and there's very little red tape between you and production. The practical stuff Our packages include equity, and it's early enough that it actually means something, not a rounding error. Orlando also means your comp survives contact with your cost of living, and Florida has no state income tax. We're backed by Define Ventures, led by a 2x founder, and our VP of Engineering came from DeepMind.