Engineering Manager, AI Orchestrator

About the Role

Referrals are where care falls apart. A specialist referral leaves a primary care office as a fax, gets keyed into a queue by hand, waits on a phone call that nobody picks up, and lands back in an EHR days later with half the clinical context missing. Roughly a third never close the loop at all.

Orchestrator is the product that fixes this. It ingests referrals however they arrive (fax, phone, direct EHR feed), extracts the clinical and demographic data, handles the outbound coordination work that today eats a coordinator's entire day, and writes the result back into the EHR of record. It is a mix of document AI, voice automation, and hard integration engineering, sitting on top of a full-stack product that referral coordinators live in for eight hours a day.

We are looking for an Engineering Manager to lead the team building it. This is an existing team with a shipping product and real customers, and you will grow it meaningfully over the next year. You will own delivery, drive the architecture decisions, and run your own hiring, working closely with the Director of Engineering on roadmap and prioritization. This is a good fit if you have a year or two of management under you, a deep engineering background, and you want the scope to grow quickly.

What You'll Do

• Own delivery for Orchestrator end to end: intake pipeline, coordinator-facing application, voice automation, and EHR write-back.

• Grow the team through hiring, and raise the technical bar as you do it. You will be running loops, closing candidates, and onboarding.

• Stay technical. You will be in design docs, in code review, and on the occasional production incident. This is not a role where you stop reading diffs.

• Set the integration strategy. Decide where we invest in durable interfaces (HL7 v2, FHIR, X12) versus where automation against the UI is the only option, and make those tradeoffs explicit.

• Get the system ready for the next order of magnitude. Referral volume, customer count, and integration count are all growing, and the current architecture was built for the stage before this one.

• Partner directly with existing customers, including the ones with the most complicated workflows. You will be on calls with health system IT, interface analysts, and clinical operations leads, translating between what they can support and what we need.

• Turn those conversations into a generalized product. Every customer will describe their referral process as unique, and some of them will be right. Your job is to find the shared abstraction underneath, build that, and configure around the edges rather than forking the product per account.

• Coach the engineers on your team into larger scope, and give direct feedback when scope is not being met.

What You Have

Required

• Direct experience building software that integrates with EHRs. You have shipped and supported an integration against at least one major EHR platform, and can speak concretely about how it went wrong.

• Working fluency in healthcare interoperability: HL7 v2 message structure, FHIR resources, and the operational reality of interface engines and site-specific customization.

• Strong full-stack engineering background. You have built and operated production services and the interfaces on top of them, and you have opinions about both.

• At least 1 year managing engineers, on top of 5 or more years as an IC engineer. We care more about the depth of the IC foundation than the length of the management track record.

• Comfort with ambiguity in the problem space. Requirements here come from watching a coordinator work, not from a spec.

• A track record of building products that serve many customers rather than one. You have said no to a well-funded one-off request, or said yes and then paid for it, and you can explain how you decide.

Nice to have

• Experience with document AI or OCR pipelines at scale.

• Experience with voice agents or telephony infrastructure (SIP, IVR navigation, real-time speech).

• Background in referral management, prior authorization, care coordination, or revenue cycle.

• Experience selling and supporting into large health systems, including security review and integration onboarding.