Staff Software Engineer, Distributed Systems

Ambience Healthcare•San Francisco, CA

2d•$250,000 - $300,000•Hybrid

About The Position

Ambience Healthcare is the leading AI platform for documentation, coding, and clinical workflow, built to reduce administrative burden and protect revenue integrity at the point of care. Trusted by top health systems across North America, Ambience’s platform is live across outpatient, emergency, and inpatient settings, supporting more than 100 specialties with real-time, coding-aware documentation. The platform integrates directly with Epic, Oracle Cerner, athenahealth, and other major EHRs. Founded in 2020 by Mike Ng and Nikhil Buduma, Ambience is headquartered in San Francisco and backed by Oak HC/FT, Andreessen Horowitz (a16z), OpenAI Startup Fund, Kleiner Perkins, and other leading investors. Join us in the endeavor of accelerating the path to safe & useful clinical super intelligence by becoming part of our community of problem solvers, technologists, clinicians, and innovators. The Role: Ambience processes millions of patient encounters across the nation's largest health systems. These organizations trust us with real-time clinical workflows where latency and reliability directly impact patient care. A slow response during a patient visit isn't just a bad metric; it's a physician abandoning the tool. You'll own the core systems that let Ambience scale reliably: database architecture, caching, multi-tenancy, and the performance optimization that determines whether our products feel fast or frustrating to clinicians. You'll design database architecture that handles our growth trajectory, build caching systems that keep EHR API latency out of critical paths, and create multi-tenant infrastructure that isolates customer data without sacrificing performance. The goal: infrastructure that other teams depend on without thinking about it. Our engineering roles are hybrid in our SF office (3x/week).

Requirements

7+ years in software engineering, 3+ focused on infrastructure, backend systems, or platform engineering
Staff-level scope: owned cross-cutting infrastructure, debugged production issues that stumped others
Strong backend fundamentals in Python, Go, TypeScript, or similar
Deep experience with relational databases (Postgres preferred)
Comfort reading code across the stack to trace performance issues
Track record of diagnosing and solving scaling or reliability problems
In SF, 3x/week in-person

Responsibilities

Database Architecture & Scaling — Own database performance end-to-end: query optimization, indexing strategy, connection management, capacity planning. Design multi-tenant data patterns that maintain performance while balancing isolation tradeoffs.
Caching & Latency Optimization — Build caching infrastructure that keeps EHR API latency out of critical user paths. Identify and optimize hot paths across the application. Build instrumentation to catch performance regressions before they reach users.
Rate Limiting — Design systems that respect EHR API rate limits while maintaining user experience. Build infrastructure that degrades gracefully under load: queue management, circuit breakers, load shedding.
Reliability & Observability — Dashboards and alerting for database performance, cache hit rates, connection pool utilization, API latency by customer. Systematically identify and harden against failure modes: connection exhaustion, cache stampedes, thundering herds.