Staff Software Engineer, Distributed Systems

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.

• 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.

• 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.

Working at Ambience means opting into a high-ownership, high-trust environment built for people who want to grow fast, operate decisively and focus on work that matters. This could be the right place for you if you want to

• 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.
• Join a “dream team” culture where we hire exceptional people, expect exceptional outcomes and invest deeply in feedback and continuous growth. We operate as a championship team, and that means being ok with hard, uncomfortable, ambiguous problems that lead to real greatness.
• Operate with real ownership and accountability in an environment where there are no bystanders: If something is broken, we fix it! You will have meaningful autonomy and be expected to drive work to completion.

To help you do your best work, we pair these expectations with benefits intentionally designed to help you feel supported and safe at Ambience and beyond. Some of our key benefits include

• Comprehensive medical, dental, and vision coverage for you and your dependents
• 401(k) with a company match of up to 3% of base salary
• A remote-friendly culture (with a San Francisco HQ) and full equipment provisioning to ensure you can work effectively from wherever you’re based.
• Parental leave to support your family needs
• Annual company-wide off-sites, team off-sites and regular team lunches and all-hands gatherings, with travel, lodging and meals covered
• Flexible time off with no annual cap, company-wide holidays and an annual holiday shutdown from December 24–January 1 designed to support real rest and long-term sustainability.

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 accommodations@ambiencehealthcare.com recruiting@ambiencehealth.com. We’ll handle your request confidentially and work with you to ensure an accessible and equitable experience for all candidates.

Ambience Healthcare has become aware of scams targeting jobseekers with fake jobs and even interviewing people. Our emails will always come from @ambiencehealthcare.com. We would never our ask candidates to download apps or make any form of payment(s). If you are contacted through WhatsApp, Telegram, similar but fake email domains, or asked to make a payment, these contacts are not legitimate. Report the issue immediately to LinkedIn and the FBI https://www.fbi.gov/how-we-can-help-you/scams-and-safety.

Here at Ambience, we never set out to be just another scribe. We’re building the AI intelligence platform that restores humanity to healthcare and drives meaningful ROI for health systems across the country.

Our technology helps providers focus on delivering great care by removing the administrative burden that pulls them away from patients and away from their most impactful work. Ambience delivers real-time coding-aware documentation and clinical workflow support across ambulatory, emergency and inpatient settings at the top health systems in North America.

Our teams operate relentlessly with extreme ownership to build the best solutions for our health system partners. We value candor, positivity and deep thought — and we expect a lot from each other because we know the problems we’re solving truly matter.

Ambience was ranked #1 for Improving the Clinician Experience in the KLAS Research Emerging Solutions Top 20 Report, recognized by Fast Company as one of the Next Big Things in Tech, named one of the best AI companies in healthcare by Inc., and selected as a LinkedIn Top Startup in 2024 and 2025. We’re backed by Oak HC/FT, Andreessen Horowitz (a16z), OpenAI Startup Fund, and Kleiner Perkins — and we’re just getting started.