Staff Software Engineer, Distributed Systems

About Us: 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. 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-t