Principal Backend Engineer

TRANSFORM HEALTHCARE WITH US. At Qualified Health, we’re redefining what’s possible with Generative AI in healthcare. Our infrastructure provides the guardrails for safe AI governance, healthcare-specific agent creation, and real-time algorithm monitoring, working alongside leading health systems to drive real change. This is more than just a job. It’s an opportunity to build the future of AI in healthcare, solve complex challenges, and make a lasting impact on patient care. If you’re ambitious, innovative, and ready to move fast, we’d love to have you on board. JOB SUMMARY We’re looking for a Principal Backend Engineer to shape the technical direction and architecture of our generative AI healthcare SaaS platform. As one of the most senior individual contributors on our engineering team, you will lead the design and evolution of critical backend systems, solve complex technical challenges, and establish engineering foundations that enable us to scale reliably and securely. You will work closely with engineering, product, AI, and security leadership to translate business priorities into long-term technical strategy, drive high-impact initiatives across teams, and make architectural decisions that balance rapid innovation with operational excellence. This is a hands-on technical leadership role. You will work directly on our hardest engineering problems while multiplying the impact of engineers around you, raising engineering standards, and helping shape the technical culture of a rapidly growing organization. KEY RESPONSIBILITIES - Technical Strategy & Architecture: Define and drive the long-term technical direction for our core backend systems and services. Establish architectural principles and guide critical technology decisions that enable scalability, security, reliability, and sustainable growth. - Cross-Team Technical Leadership: Identify and lead complex engineering initiatives spanning multiple teams. Build alignment around technical priorities, resolve architectural disagreements, and drive initiatives from early design through successful production operation. - Hands-On Engineering: Design, implement, and review critical components of our backend infrastructure. Foster AI first culture. Lead by example through high-quality code, thoughtful system design, and deep technical problem-solving. - Distributed Systems & Scalability: Architect resilient distributed systems, APIs, data services, and asynchronous workflows capable of supporting growing enterprise workloads, complex integrations, and evolving product requirements. - Reliability & Operational Excellence: Establish engineering practices that improve system reliability, observability, performance, and operational efficiency. Partner with Platform and Infrastructure teams on service-level objectives, capacity planning, incident prevention, and systemic improvements. - Technical Mentorship: Mentor Senior and Staff engineers, develop emerging technical leaders, and foster a culture of technical rigor, collaboration, ownership, and continuous improvement. - Strategic Partnership: Collaborate with engineering, product, and business leadership to evaluate technical investments, make build-versus-buy decisions, manage architectural trade-offs, and balance near-term delivery with long-term platform sustainability. REQUIRED QUALIFICATIONS - Demonstrated track record of architecting, building, and operating complex, large-scale backend or platform systems in production, with measurable technical and business impact. - Deep expertise in distributed systems, including service architecture, data consistency, concurrency, fault tolerance, scalability, and performance optimization. - Expert-level proficiency in at least one modern backend programming language, with the ability and willingness to work extensively in Python. - Strong experience designing and operating cloud-native applications on AWS, GCP, or Azure, with an understanding of infrastructure automation, deployment practices, and production operations. - Deep understanding of API design, data modeling, databases, asynchronous processing, and modern backend architectural patterns. - Ability to navigate ambiguity, independently identify important technical problems, and translate complex requirements into pragmatic, scalable engineering solutions. - Demonstrated ability to improve engineering effectiveness through architectural simplification, reusable systems, mentorship, and technical standards. - Ability to work on-site in our Palo Alto office three days per week. DESIRABLE QUALIFICATIONS - Experience designing, building, or operating production generative AI applications, LLM-powered workflows, or AI infrastructure. - Experience building multi-tenant enterprise SaaS platforms with strong requirements for security, isolation, scalability, and availability. - Experience with Google Cloud Platform, Kubernetes, Terraform, and modern monitoring and observability tooling. - Experience building systems in regulated environments, including healthcare, financial services, or other industries with stringent data privacy and security requirements. - Familiarity with HIPAA, SOC 2, or comparable security and compliance frameworks. - Experience establishing technical foundations, engineering standards, and architectural direction in rapidly growing organizations. WHY JOIN QUALIFIED HEALTH? This is an opportunity to join a fast-growing company and a world-class team that is poised to change the healthcare industry. We are a passionate, mission-driven team building a category-defining product. We are backed by premier investors and are looking for founding team members who are excited to do the best work of their careers. Our employees are integral to achieving our goals, so we are proud to offer competitive salaries with equity packages, robust medical/dental/vision insurance, flexible working hours, hybrid work options, and an inclusive environment that fosters creativity and innovation. OUR COMMITMENT TO DIVERSITY Qualified Health is an equal opportunity employer. We believe that a diverse and inclusive workplace is essential to our success, and we are committed to building a team that reflects the world we live in. We encourage applications from all qualified individuals, regardless of race, color, religion, gender, sexual orientation, gender identity or expression, age, national origin, marital status, disability, or veteran status. Pay & Benefits The pay range for this role is between $230,000 and $280,000, and will depend on your skills, qualifications, experience, and location. This role is also eligible for equity and benefits. Join our mission to revolutionize healthcare with AI. To apply, please send your resume through the application below.