Senior Software Engineer

About the Role

As a Senior Software Engineer, you will be responsible for developing and maintaining mission-critical systems that power healthcare operations and interoperability for over 60 clinics and health systems.

At Health Note, we’re not building new AI models — we’re integrating LLMs and AI services into our products to deliver digital assistants that grow new skills over time and transform healthcare operations into a continuous improvement process. The result is automation that is both reliable and human-centered, giving patients and providers an experience they can trust.

You’ll work as part of a cross-functional team to design AI-enabled solutions, shape architectural decisions, and ensure AI is thoughtfully incorporated into our platform. We look for engineers who bring a product mindset — considering usability, speed-to-market, and long-term impact alongside technical execution.

We’re a fully distributed, remote-first startup. We recommend core working hours of ET 12–4pm and rely heavily on clear asynchronous communication. Occasionally, you’ll need to flex to sync with teammates across time zones.

Our stack is full-stack Typescript (NestJS, React, Remix, Tailwind, GraphQL, PostgreSQL, Redis, Pulumi), all on AWS, in a service-oriented Monorepo architecture.

Responsibilities

• Design, implement, and maintain scalable, high-performance services and applications.
• Integrate LLMs and AI services into production systems with attention to safety, observability, performance, and cost-effectiveness.
• Build abstractions, APIs, and tooling that make it easier for engineers and product teams to use AI responsibly.
• Approach problems with a product engineer mindset: balance technical tradeoffs with user experience, speed-to-market, and long-term maintainability.
• Improve code quality through refactoring, automated testing, CI/CD, and strong developer productivity practices.
• Mentor engineers and contribute to shared standards, ensuring long-term maintainability.
• Collaborate with cross-functional teams to design AI-enabled product experiences that meet client needs.

Qualifications

• 5+ years of experience building robust, scalable full-stack applications and developer tools.
• Hands-on experience with LLMs or AI services (e.g., OpenAI, Anthropic, Vertex AI, Llama).
• Significant experience designing, building, deploying, and maintaining production applications at scale.
• Proficiency with Javascript/Typescript, React, NodeJS (NestJS), and PostgresQL.
• Familiarity with modern web technologies (HTTP2, WebSockets, gRPC, GraphQL).
• Strong engineering craft: able to architect solutions to ambiguous problems and leave the codebase better than you found it.
• A product-oriented approach: you consider usability, outcomes, and business impact alongside technical design.

Nice to Haves

• Experience designing evaluation frameworks for AI-enabled features (e.g., measuring accuracy and reliability of LLM outputs).
• Familiarity with RAG, embedding algorithms, or intent classification.
• Experience with DevOps and reliability tooling (Langfuse, Datadog, Grafana, Sentry, Cloudwatch, infrastructure-as-code, containers/Kubernetes).
• Background in healthcare, regulated industries, or EHR/EMR integration.
• Experience debugging distributed systems.

You do not need to have prior experience with every technology in our stack. We believe great candidates can learn quickly, and we provide mentorship and guidance as needed.