Staff Software Engineer, Distributed Systems

About Ambience Healthcare

Ambience is building the AI intelligence platform that restores humanity to healthcare and drives meaningful ROI for health systems across North America. Our real-time coding-aware documentation and clinical workflow support removes administrative burden from providers, allowing them to focus on patient care. Ranked #1 for Improving Clinician Experience by KLAS Research, recognized by Fast Company as a Next Big Thing in Tech, and backed by Oak HC/FT, Andreessen Horowitz, OpenAI Startup Fund, and Kleiner Perkins.

The Role

You'll own the core distributed systems that enable Ambience to scale reliably across millions of patient encounters at the nation's largest health systems. In this critical infrastructure role, latency and reliability directly impact clinical workflows—a slow response during a patient visit means physicians abandon the tool. 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.

Goal: Infrastructure that other teams depend on without thinking about it.

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.
• Rate Limiting & API Resilience — Design systems that respect EHR API rate limits while maintaining user experience. Build infrastructure that gracefully handles upstream service constraints.
• Multi-Tenancy & Data Isolation — Architect systems where tenant data remains isolated without sacrificing shared resource efficiency or performance.
• Observability & Monitoring — Instrument systems to detect bottlenecks, track performance metrics, and enable rapid diagnosis of production issues affecting clinician experience.

Work Environment

This is a hybrid role requiring 3 days per week in our San Francisco office.