About Health Note

At Health Note, we’re on a mission to humanize healthcare administration. We automate the entire patient journey from the first phone call to the final follow-up, enabling health systems to connect patients with the right physicians, gather precise and relevant data, and maintain empathy at the heart of every interaction.

We are building AI-powered digital assistants that act like trusted members of the care team. Instead of rigid, disconnected software modules, our assistants 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 for every patient, and a scalable path to automation for every clinic.

About the Role

As a Senior Software Engineer, you will be responsible for developing 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 integrating LLMs and AI services into our products to deliver digital assistants that grow new skills over time and transform healthcare operations into a continuous improvement process. The result is automation that is both reliable and human-centered, giving patients and providers an experience they can trust.

You’ll work as part of a cross-functional team to design AI-enabled solutions, shape architectural decisions, and ensure AI is thoughtfully incorporated into our platform. We look for engineers who bring a product mindset — considering usability, speed-to-market, and long-term impact alongside

technical execution.

We’re a fully distributed, remote-first startup. We expect core working hours of ET 12–4pm and rely heavily on clear asynchronous communication. Occasionally, you’ll need to flex to sync with teammates across time zones. Candidates outside the US should be open to contractor engagements.

Our stack is full-stack Typescript (NestJS, React, Remix, Tailwind, GraphQL, PostgreSQL, Redis, Pulumi), all on AWS, in a service-oriented Monorepo architecture.

Responsibilities

Design, implement, and maintain scalable, high-performance services and applications.
Integrate LLMs and AI services into production systems with attention to safety, observability, performance, and cost-effectiveness.
Build abstractions, APIs, and tooling that make it easier for engineers and product teams to use AI responsibly.
Approach problems with a product engineer mindset: balance technical tradeoffs with user experience, speed-to-market, and long-term maintainability.
Improve code quality through refactoring, automated testing, CI/CD, and strong developer productivity practices.
Mentor engineers and contribute to shared standards, ensuring long-term maintainability.
Collaborate with cross-functional teams to design AI-enabled product experiences that meet client needs.

Qualifications

5+ years of experience building robust, scalable full-stack applications and developer tools.
Hands-on experience with LLMs or AI services (e.g., OpenAI, Anthropic, Vertex AI, Llama).
Significant experience designing, building, deploying, and maintaining production applications at scale.
Proficiency with Javascript/Typescript, React, NodeJS (NestJS), and PostgresQL.
Familiarity with modern web technologies (HTTP2, WebSockets, gRPC, GraphQL).
Strong engineering craft: able to architect solutions to ambiguous problems and leave the codebase better than you found it.
A product-oriented approach: you consider usability, outcomes, and business impact alongside technical design.

Nice to Haves

Experience designing evaluation frameworks for AI-enabled features (e.g., measuring accuracy and reliability of LLM outputs).
Familiarity with RAG, embedding algorithms, or intent classification.
Experience with DevOps and reliability tooling (Langfuse, Datadog, Grafana, Sentry, Cloudwatch, infrastructure-as-code, containers/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 can learn quickly, and we provide mentorship and guidance as needed.

Not all applicants will have skills that match a job description exactly. Health Note values diverse experiences in other industries and we encourage everyone who meets the required qualifications to apply. While having “desired” attributes makes for a strong candidate, we encourage applicants with alternative experiences to apply. We are always looking for people who will bring something new to the table!

Working at Health Note:

At Health Note, we believe in taking care of our team members by providing a wide range of ways to support their professional growth, mental and physical well-being, and work-life balance. We are always looking for new ways to help our employees thrive!

Health and Wellness - We offer comprehensive health benefits, including medical, dental, and vision, as well as disability and life insurance coverage. We also offer a 401k with a company match.

Work Life Balance - We know that everyone has a life away from work! We encourage our employees to adjust their work schedules to balance family responsibilities and offer a flexible PTO policy to encourage everyone to take time away from work and recharge as needed.

Team Culture - Join a dynamic and collaborative team environment where your contributions are valued and your voice is heard. We host regular team-building activities, social events, and more.

Continuous Learning - We encourage personal and professional growth with access to learning resources, training programs, and opportunities for career advancement.

Committed to Diversity, Equity, and Inclusion

Health Note is an Equal Opportunity Employer and is committed to fair hiring practices. All hiring decisions at Health Note are based on business requirements, job needs and individual qualifications. Each candidate is considered without regard to race, color, religion, gender, sexuality, national origin, age, disability, genetics or any other protected status.

Careers

We’re automating the front door of healthcare.

Come help us build what’s next.

Open Positions