Principal Software Engineer

Foundation Health•Orlando, FL

7d•Onsite

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. You'll be the technical anchor for our brand new engineering hub in Orlando, working directly alongside our VP of Engineering (ex-DeepMind/Google) and a 2x Founder CEO. Owning architecture across multiple product areas. Setting the standards everyone else builds to. Making the calls that decide where this platform is in two years, not just this quarter. One thing we're clear on: this isn't an ivory-tower architect role. You'll lead system design and get into the codebase when it matters. At Foundation Health, technical credibility comes from doing, not directing. And you're doing it on a greenfield codebase. No decade of technical debt, no committee sign-offs, no waiting three sprints for someone to approve a migration. Hard, interesting problems — and the autonomy to solve them properly. Everything you ship touches real patient care in real health systems. We're past product-market fit. Enterprise health systems are live on the platform and asking for more — the "will anyone buy this" question is answered. Now we build. The influence here is real — on the architecture, the culture, and the direction of the entire engineering org. We've done the hard part of proving people want this. Now we build.

Requirements

You've built complex systems from scratch — and you can still get into the code, not just review it
Strong engineering judgment: you know when to move fast and when to slow down, and you frame technical decisions in business terms
Genuine AI fluency — you've shipped AI-powered products, and AI tooling is a natural part of how you work, not a box you tick
High agency: you don't wait for a perfectly scoped ticket, you figure out what needs to happen and do it
US-based, or willing to relocate to Orlando

Responsibilities

Own platform architecture. Design systems that handle 10-100x growth without a rewrite.
Establish the patterns the wider engineering org adopts.
Spot the root-cause problems before they get expensive.
Define how we use AI — everywhere. Not just in the product (voice agents, clinical workflows), but in how the engineering org itself works.
Own model selection, latency and cost tradeoffs, evaluation methodology, and the quality and safety bar for everything AI-related that ships.
Shape the roadmap, not just execute it.
Work directly with product leadership.
Push back where it's needed.
Separate what's high-leverage from what's noise.
Drive cross-team initiatives where success means product outcomes, not ticket throughput.
Grow the engineers around you.
Help build the next generation of technical leaders in the hub — by example first, mentorship second.