Staff Software Engineer, Distributed Systems

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 — working onsite at our San Francisco office three days per 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.

• 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.

Who You Are: 

• 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

Why Here:

Ambience powers real-time clinical workflows at the country's largest health systems. Latency and reliability directly impact whether physicians adopt the tool. This isn't theoretical scaling; it's infrastructure that matters.

Healthcare adds interesting constraints. Multi-tenancy has compliance implications. Caching patient data requires thinking about retention and access controls. Your infrastructure decisions have downstream security and privacy consequences.

We're growing rapidly across customers, encounters, and product surface area. The investments you make now will determine how smoothly we handle 10x growth. Small team, high trust, direct access to leadership. Staff engineers here shape technical direction, not just execute on it.

• 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.

• Comprehensive medical, dental, and vision coverage for you and your dependents

• Parental leave to support your family needs