Principal Software Engineer

About us:

ecares health is a healthcare technology startup spun out of Essen Health Care, a large multispecialty provider group in the Bronx. We're building the care coordination OS that brings concierge medicine to underserved communities. Our platform powers proactive outreach, intelligent care programs, and automated scheduling, helping provider groups ensure no patient falls through the cracks.

Through our unique relationship with Essen Health Care, we have access to clinical and operational experts who help drive our product strategy and refine our vision. Our platform is currently live with active users at Essen, and we are finalizing expansion to more practices across New York City in the coming months.

Why ecares

Healthcare is full of absurd complexity: a patient has two tax IDs, three insurance plans, referrals that expire in ways that don't make sense, and an EHR that was built in 1999. A clinical rule that sounds simple ("high-risk diabetes patients should see endocrinology every 90 days") touches eligibility logic, scheduling constraints, provider credentialing, and half a dozen integrations.

There are a hundred health tech startups with AI in their names, but few are interested in leveraging LLMs, and other cutting-edge technology, to build the operational infrastructure that makes care coordination work. And none are as committed as we are to the belief that technology is society's strongest lever to improve health at a population level.

Position title: Principal Software Engineer 

Job Summary:We're hiring a Principal Software Engineer to set the technical direction and own the architecture of our core systems. This is a hands-on senior leadership role. You'll design and evolve foundational systems (APIs, data flows, infrastructure patterns, reliability standards) while acting as a force multiplier for the engineering team.

What you’ll own

· Platform-wide architecture across backend services and infrastructure

· Technical scoping and design for cross-cutting initiatives (EHR integrations, multi-tenancy, scaling)

· Reliability, scalability, and operational excellence

· Developer experience and internal tooling

· Engineering standards and best practices

· High-impact system redesigns and architectural improvements

· Engineering leverage through mentorship and code review

30/60/90-day plan

Days 0 to 30

· Deep dive into platform architecture, codebase, and infrastructure

· Audit scaling bottlenecks and reliability risks

· Build strong working relationships with the engineering team and clinical stakeholders

· Identify 2-3 high-leverage platform improvements

· Ship at least one meaningful architectural fix

Days 31-60

· Own the technical design for a major architectural initiative

· Refine or establish platform-wide engineering standards

· Improve observability and reliability patterns across services

· Begin scoping and architecting work for other engineers to execute

Days 61-90

· Recognized as the technical authority for your domain

· Delivering on your first major initiative

· Actively shaping the technical roadmap alongside product and leadership

· Mentoring engineers and raising the bar on code quality and design rigor

What we’re looking for

· 7+ years of professional software engineering experience, with principal-level impact in at least one prior role

· Designed and operated large-scale distributed systems in production

· Strong backend engineering background; comfortable working across the full stack

· Excellent architectural judgment and ability to translate messy, real-world problems into clean technical designs

· Experience working in healthcare, EHR integrations, or compliance-heavy environments is a significant plus

· Comfortable owning systems end-to-end, from design through production operations

Our stack: Python (FastAPI), React/TypeScript, MSSQL, Redis, Azure (Container Apps, Static Web Apps, DevOps Pipelines), Terraform.

Nice to have

· Health tech experience or familiarity with EHR systems (eClinicalWorks, Ellkay, Redox, FHIR)

· Experience with HIPAA-compliant systems and healthcare data

· Experience scaling a multi-tenant SaaS platform

· Experience building clinical rules engines or decision support systems

· Public speaking or writing on technical topics

Location

Based in the Bronx, co-located with Essen Health Care. We sit next to the care coordinators, clinicians, and operators who use the platform every day and work in a community that we serve. Instead of scheduling a user research session, you can walk down the block and see someone using what you built.

Hybrid: 3 days on-site, 2 days remote.

Why this role

You’ll shape the technical foundation of a platform that’s live, growing, and directly improving healthcare for underserved communities.

Essen Health Care and ecares health are Equal Opportunity Employers and are committed to creating an inclusive, diverse, and equitable workplace for all.