Principal Software Engineer
About The Position
Foundation Health is an AI operating system for pharmacy, built by a team with firsthand experience in the industry's challenges. They aim to use AI to streamline prior authorizations, reduce administrative work for pharmacists, and prevent prescriptions from being missed. The company is developing integrated infrastructure to improve care coordination, specifically for specialty pharmacy. Their vision is for pharmacy teams to focus on patient care, with AI handling routine tasks. The company's platform is currently live in major US health systems, including Intermountain Health, where its AI handles patient communication via voice and SMS and integrates with Epic workflows. They have a public partnership with Amazon Pharmacy and have raised $20M in Series A funding led by Define Ventures. The team consists of approximately 70 people, has achieved product-market fit, and is experiencing rapid growth driven by enterprise customers. This is the most senior individual contributor (IC) role in the US organization. The successful candidate will be responsible for architecture across multiple product areas, designing systems capable of supporting significant growth without requiring a complete rewrite. They will also be hands-on in solving the company's most challenging technical problems, prototyping solutions for complex issues. The role involves direct collaboration with the VP of Engineering and CEO, with a management style that emphasizes hands-on involvement at all levels. Key technical areas of ownership include: - Agentic AI in a regulated environment: developing voice and SMS agents for patient interaction, ensuring safety through evaluations, guardrails, and pharmacist oversight. - Deep EHR integration: working with systems like Epic queues, prior authorization automation, and 340B compliance, where accuracy is critical. - Target-state architecture: designing and building the initial stages of platform migration to support scaling from a few health systems to hundreds. - AI engineering: focusing on model selection, context management, cost/latency trade-offs, and evaluation methodologies.
Requirements
- Deep engineering background.
- Proven experience building serious systems with your own hands, recently (not managing people who did).
- Ability to go toe-to-toe on the details of anything shipped.
- Operated at Staff+ level somewhere with a genuinely high bar.
- Ability to point at architectural decisions a company still runs on.
- Hands-on fluency with applied AI; experience building with LLMs in production.
- High agency: ability to find the highest-leverage problem in the organization and solve it independently.
Responsibilities
- Own architecture across multiple product areas, designing systems that can support 10–100x growth without a rewrite.
- Build the first version of solutions for the company's hardest problems.
- Work directly with the VP of Engineering and CEO.
- Develop voice and SMS agents interacting with real patients, with the necessary evals, guardrails, and pharmacist-oversight architecture.
- Integrate systems with Epic queues, prior authorization automation, and 340B compliance.
- Design and build the initial migration for the target-state architecture.
- Handle AI engineering tasks including model selection, context management, cost/latency tradeoffs, and evaluation methodology.
Benefits
- Remote-first across the US.
- Hub in Orlando.
- Founding-role equity.
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What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
No Education Listed
