Ambience Healthcare

Staff Software Engineer, Distributed Systems

San Francisco · Staff+

Sponsorship not specified$250k-$300kDetected 170 days ago

TypeScriptPythonGoDistributed SystemsPostgreSQLPlatform EngineeringRESTDesign SystemsEHR/EMRResearch

About 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.

Responsibilities

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.
We operate as a championship team, and that means being ok with hard, uncomfortable, ambiguous problems that lead to real greatness.
You will have meaningful autonomy and be expected to drive work to completion.

Requirements

7+ years in software engineering, 3+ focused on infrastructure, backend systems, or platform engineering

Nice to have

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

Compensation

We offer a base compensation range of approximately $250,000-$300,000 per year, exclusive of equity.
Our compensation philosophy prioritizes meaningful equity grants, enabling team members to share directly in the impact they help create.
We take an individualized approach to compensation that accounts for experience, scope, and the life factors that matter to each candidate.
401(k) with a company match of up to 3% of base salary
Annual company-wide off-sites, team off-sites and regular team lunches and all-hands gatherings, with travel, lodging and meals covered

Benefits

Work on mission-critical AI technology that directly improves clinicians' day-to-day lives and health system financial health across some of the most complex, high-stakes workflows in the world.
To help you do your best work, we pair these expectations with benefits intentionally designed to help you feel supported and safe at Ambience and beyond.
Some of our key benefits include
Comprehensive medical, dental, and vision coverage for you and your dependents
Parental leave to support your family needs

Company info

Here at Ambience, we never set out to be just another scribe. We're building the AI intelligence platform that restores humanity to healthcare and drives meaningful ROI for health systems across the country.
Our technology helps providers focus on delivering great care by removing the administrative burden that pulls them away from patients and away from their most impactful work. Ambience delivers real-time coding-aware documentation and clinical workflow support across ambulatory, emergency and inpatient settings at the top health systems in North America.
Our teams operate relentlessly with extreme ownership to build the best solutions for our health system partners. We value candor, positivity and deep thought - and we expect a lot from each other because we know the problems we're solving truly matter.
Ambience was ranked #1 for Improving the Clinician Experience in the KLAS Research Emerging Solutions Top 20 Report, recognized by Fast Company as one of the Next Big Things in Tech, named one of the best AI companies in healthcare by Inc., and selected as a LinkedIn Top Startup in 2024 and 2025. We're backed by Oak HC/FT, Andreessen Horowitz (a16z), OpenAI Startup Fund, and Kleiner Perkins - and we're just getting started.
Here at Ambience, we never set out to be just another scribe.
We're building the AI intelligence platform that restores humanity to healthcare and drives meaningful ROI for health systems across the country.
Our technology helps providers focus on delivering great care by removing the administrative burden that pulls them away from patients and away from their most impactful work.
Ambience delivers real-time coding-aware documentation and clinical workflow support across ambulatory, emergency and inpatient settings at the top health systems in North America.
Our teams operate relentlessly with extreme ownership to build the best solutions for our health system partners.
We value candor, positivity and deep thought - and we expect a lot from each other because we know the problems we're solving truly matter.
Ambience was ranked #1 for Improving the Clinician Experience in the KLAS Research Emerging Solutions Top 20 Report, recognized by Fast Company as one of the Next Big Things in Tech, named one of the best AI companies in healthcare by Inc., and selected as a LinkedIn Top Startup in 2024 and 2025.
We're backed by Oak HC/FT, Andreessen Horowitz (a16z), OpenAI Startup Fund, and Kleiner Perkins - and we're just getting started.
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).
What You'll Own:
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.
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.
Who You Are:
Staff-level scope: owned cross-cutting infrastructure, debugged production issues that stumped others

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