Principal Engineer (AI Systems)

About Foundation Health

Foundation Health is an AI operating system for pharmacy, built by a team deeply familiar with healthcare challenges. Their mission is to eliminate delays in prescriptions, reduce pharmacist paperwork, and ensure seamless coordination of care using AI. They aim to transform pharmacy teams' focus from paperwork to patient care.

Their platform is already live in production within major US health systems, handling real patient communication via voice and SMS, and integrating directly with Epic workflows. Errors are not tolerated, as they directly impact patient medication.

The Role

This role involves owning architecture across multiple product areas and designing scalable systems capable of growing 10–100x without requiring a complete rewrite. You will be the go-to person for tackling the most challenging problems within the company, directly opening the editor to build the first version of solutions.

You will also enhance the engineering team by mentoring, leading cross-team projects, and improving development practices, including leveraging AI to accelerate delivery without compromising quality. Experience with implementing agentic dev practices at a team or company level is highly valued.

You will report directly to the VP of Engineering (ex-DeepMind) and CEO, with a hands-on management approach at all levels.

The problems you’d own

• Agentic AI that’s safe to put in front of patients. This includes voice and SMS agents, evaluation systems, guardrails, red teaming, and pharmacist oversight to ensure trustworthiness. Experience in AI safety or LLM security in production environments is highly relevant.

• Deep EHR integration. This involves Epic queues, prior authorization automation, and 340B compliance, where precision and adherence to specifications are critical.

• Our target-state architecture. You will scale the platform from a few health systems to hundreds, building the foundational infrastructure for this migration.

• How we do AI engineering. This includes model selection, context management, cost and latency tradeoffs, and evaluation methodologies.

Who tends to do well here

• You have recently built significant systems yourself and can delve deeply into the details of anything you’ve shipped. Your title is less important than your hands-on contributions. Many successful Principals have transitioned from roles like directors or heads of departments.

• You have experience at a Staff+ level in a high-bar environment and can point to architectural decisions that continue to influence company operations.

• You have experience building with LLMs in production, beyond simple SDK calls, including agents, tool use, evaluations, guardrails, and ensuring reliability.

• You prioritize simplicity in your architecture, favoring well-structured monoliths on Postgres over complex microservices that are difficult to debug. You adjust the architecture based on real constraints rather than theoretical considerations.

• You have worked in environments where mistakes carry significant consequences, such as healthcare, fintech, fraud, trust and safety, or other compliance-sensitive fields.

• You proactively identify and solve the highest-leverage problems within the company without waiting for directives.