Senior Distributed Systems Engineer (AI)

TL;DR

Senior Distributed Systems Engineer (AI/Healthcare): Building real-time, reliable AI infrastructure for clinical documentation and decision support systems with an accent on database architecture and performance optimization. Focus on scaling Postgres, designing caching layers, and improving system reliability for high-traffic healthcare workflows.

Location: Hybrid (3 days onsite) in San Francisco, New York City, or San Jose

Salary: $150,000–$300,000

Company

An AI-powered clinical documentation platform transforming healthcare delivery by automating workflows and reducing administrative burden for U.S. health systems.

What you will do

• Design and scale database architecture, focusing on Postgres query optimization, indexing, and capacity planning.
• Develop caching systems to eliminate latency from critical user paths.
• Optimize system performance across high-traffic, real-time clinical applications.
• Design and implement rate limiting and load management systems.
• Enhance reliability and observability across core platform infrastructure.

Requirements

• 7+ years of professional software engineering experience.
• Strong backend proficiency in Python, Go, TypeScript, or similar languages.
• Deep experience with relational databases, specifically PostgreSQL.
• Proven track record of scaling systems and solving complex performance and reliability issues.
• Experience owning infrastructure or platform systems end-to-end.
• Must be based in or able to work hybrid in San Francisco, New York City, or San Jose.

Nice to have

• Experience with high-scale, low-latency systems.
• Background in infrastructure, platform, or reliability engineering.
• Previous experience working in healthcare or other regulated environments.
• Startup experience with a high degree of ownership.

Culture & Benefits

• Opportunity to work with frontier AI deployed in production with direct impact on patient care.
• High-scale, real-time infrastructure challenges within a high-growth trajectory.
• Clear path toward IPO or acquisition.
• Collaboration with a high-caliber engineering team and a strong ownership culture.