Principal Software Engineer

Foundation Health

19d•Hybrid

About The Position

Foundation Health is an AI operating system for pharmacy, built by a team who lived the problem firsthand. 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. 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.

Requirements

Built serious systems with your own hands recently, and can go deep on the details of anything you’ve shipped.
Worked at Staff+ level somewhere with a high bar, and can point to architectural decisions a company still runs on.
Built with LLMs in production, well beyond SDK calls: agents, tool use, evals, guardrails, and the unglamorous work of making them reliable.
Keep things as simple as the problem allows; prefer a well-structured monolith on Postgres over ten microservices nobody can debug.
Change architecture when real constraints show up, not before.
Worked somewhere mistakes are expensive (e.g., healthcare, fintech, fraud, trust and safety, or anywhere compliance shapes design).
Find the highest-leverage problem in the company and solve it without waiting to be pointed at it.
Experience with agentic AI safety or LLM security in production.
Experience with deep EHR integration, Epic queues, prior authorization automation, and 340B compliance.
Experience with AI engineering including model selection, context management, cost and latency tradeoffs, and evaluation methodology.
Experience rolling out agentic dev practices at a team or company level and showing the impact on output and quality.

Nice To Haves

Experience in healthcare is not required, but a willingness to care about getting it right is.
Experience as a director or head of something without ever stopping building.

Responsibilities

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, open the editor and build the first version.
Make the rest of engineering better through mentoring and leading projects across teams.
Change how the company builds, including how AI is used to ship faster without shipping worse.
Work directly with the VP of Engineering and CEO.