Senior Software Engineer – LLM

About Health Note

Health Note is building AI-powered digital assistants that act like trusted members of the care team. Instead of rigid,disconnected software modules, ourassistants gain skills over time — from handling simple reschedules to managing complex intake, referrals, and medication refills. Patients experience a natural,empathetic interaction, while providers gain a system that is reliable, transparent, and continually improving. Our goal is to deliver a concierge experience forevery patient, and a scalable path to automation for every clinic.

About the Role

This role is an opportunity to join a high-impact team with tremendous growth opportunities. As a Senior Software Engineer, you will be responsible fordeveloping and maintaining mission-critical systems that power healthcare operations and interoperability for over 60 clinics and health systems.

At Health Note, we’re not building new AI models — we’re using services to deliver digital

assistants that act like trusted members of the care team. These assistants grow new skills over time, handle complex patient-facing workflows safely andreliably, and transform healthcare operations into a continuous improvement process. The result is not just reliable automation, but a human and empatheticexperience that patients and providers trust.

As part of a cross-functional team, you’ll collaborate with product managers, solution engineers, and client experience managers to create world-class, AI-enabled solutions. You’ll shape architectural decisions, integration patterns, and developer workflows so that AI isn’t just “bolted on,” but thoughtfullyincorporated into our platform.

This opportunity is ideal if you want to take the next step in your career and join a growth-stage organization focused on healthcare — while working at thefrontier of AI-enabled software development.

We’re a fully distributed, remote-first, fast-growing startup. Our engineering team is spread from UTC-3 to UTC-7 and we rely heavily on strong asynchronouscommunication. Occasionally, you’ll need to flex to sync up with teammates across time zones.

Our cutting-edge stack is full-stack Typescript leveraging NestJS, React, Remix, Tailwinds,GraphQL, PostgreSQL, Redis, Pulumi, all on AWS. Our architecture isservice oriented and managed in a Monorepo.

Responsibilities

• Design, implement, and maintain highly scalable and performant servicesand applications.
• Integrate LLMs and AI services into production systems, with attention tosafety, observability, performance, and cost effectiveness.
• Build abstractions, APIs, and internal tooling that make it easier for otherengineers and product teams to leverage AI responsibly.
• Continually improve the codebase and test coverage through refactoring,automated testing, CI/CD, and strong developer productivity practices.
• Experiment with emerging AI technologies and evaluate their fit for ourproducts, balancing speed-to-market with reliability.
• Mentor and support other engineers, setting coding standards andarchitectural practices that ensure long-term maintainability.
• Collaborate with cross-functional teams to design AI-enabled productexperiences that meet real client needs.

Qualifications

• 5+ years of experience building robust, scalable full-stack applications,databases, and developer tools.
• Hands-on experience working with LLMs or AI services (e.g., OpenAI,Anthropic, Vertex AI, Llama) in a professional or personal capacity.
• Significant experience designing, building, deploying, and maintainingproduction applications at scale.
• Proficiency with Javascript/Typescript, React, NodeJS (NestJS), andPostgresQL.
• Familiarity with modern web technologies (HTTP2, WebSockets, gRPC,GraphQL).
• Comfort architecting solutions to ambiguous problems with significantimpact.
• Experience leaving the codebase better than you found it throughautomated testing, CI/CD, and observability.

Nice to Haves

• Experience designing evaluation frameworks for AI-enabled features (e.g.,measuring quality, accuracy, and reliability of LLM outputs).
• Familiarity with RAG, embedding algorithms, and intent classification.
• Experience with observability and monitoring systems (Langfuse,Datadog, Grafana, Sentry, Cloudwatch, etc.).
• Experience with infrastructure-as-code in production.
• Familiarity with internal UI and integration tools (ReTool, SalesforceCommunities, Contentful, NextJS, etc.).
• Experience with containers and orchestrators like Docker or Kubernetes.
• Background in healthcare, regulated industries, or EHR/EMR integration.
• Experience debugging distributed systems.

You do not need to have prior experience with every technology in our stack. We believe great candidates are capable of learning new tools quickly, and weprovide mentorship and guidance as needed.

We offer:

• We welcome new ideas and allow you to make an immediate impact on the team.
• Flexible Paid time off (PTO for any reason, including sick days (no specified limits) and flexible work schedule.
• Personal laptop.
• Health/Sport Budget.
• Fully remote.