Staff Software Engineer, Distributed Systems

About Us:

Ambience Healthcare is the leading AI platform for documentation, coding, and clinical workflow, built to reduce administrative burden and protect revenue integrity at the point of care. Trusted by top health systems across North America, Ambience’s platform is live across outpatient, emergency, and inpatient settings, supporting more than 100 specialties with real-time, coding-aware documentation. The platform integrates directly with Epic, Oracle Cerner, athenahealth, and other major EHRs. Founded in 2020 by Mike Ng and Nikhil Buduma, Ambience is headquartered in San Francisco and backed by Oak HC/FT, Andreessen Horowitz (a16z), OpenAI Startup Fund, Kleiner Perkins, and other leading investors.

Join us in the endeavor of accelerating the path to safe & useful clinical super intelligence by becoming part of our community of problem solvers, technologists, clinicians, and innovators.

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 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.

• 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.

We offer a base compensation range of approximately $250,000–$300,000 per year, exclusive of equity. This intentionally broad range provides flexibility for candidates to tailor their cash and equity mix based on individual preferences. Our compensation philosophy prioritizes meaningful equity grants, enabling team members to share directly in the impact they help create.

Outside of this range? We still encourage you to apply. We take an individualized approach to compensation that accounts for experience, scope, and the life factors that matter to each candidate.

Being at Ambience: 

• An opportunity to work with cutting edge AI technology, on a product that dramatically improves the quality of life for healthcare providers and the quality of care they can provide to their patients

• Work alongside a world-class, diverse team that is deeply mission aligned

• Ownership over your success and the ability to significantly impact the growth of our company

• Competitive salary and equity compensation with benefits including health, dental, and vision coverage, quarterly retreats, unlimited PTO, and a 401(k) plan with matching

Ambience is committed to supporting every candidate’s ability to fully participate in our hiring process. If you need any accommodations during your application or interviews, please reach out to our Recruiting team at [email protected]. We’ll handle your request confidentially and work with you to ensure an accessible and equitable experience for all candidates.
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