Vytalize Health - Principal Software Engineer

Your Opportunity
As a Principal Engineer, you will help design, build, and operate the clinical decision support and API-driven data delivery platform that enables Vytalize Health to embed timely, actionable clinical insights directly into provider workflows. Working cross-functionally with Data Engineering, Product, Clinical Operations, and EMR partners, your solutions will transform how clinicians access data—moving from external tools and workarounds to seamless, in-workflow decision support via CDS Hooks and real-time APIs.

You will own the technical foundation for Clinical Decision Support (CDS) Hooks, REST APIs, and the architectural patterns that ensure clinical data is accessible, trustworthy, and performant at the moment of care. This role sits at the intersection of healthcare interoperability standards, modern API design, and operational excellence. You will establish reliability metrics and SLAs that ensure CDS Hooks and APIs serve clinician workflows with consistent quality and performance. You will be part of a small, high-performing healthcare engineering team where engineers support each other's growth through mentorship and tight collaboration.
Primary Responsibilities
- Lead design and implementation of the CDS Hooks platform, including card orchestration, hook context handling, EHR-side logic orchestration, and integration with downstream data services

- Own CDS Hook API contracts and evolution, ensuring compliance with SMART CDS Hooks specification while adding performance, reliability, and healthcare-specific optimizations

- Lead technical integration with EMR systems (Epic, NextGen, Athena, ECW) for CDS Hook discovery, execution, card rendering, and user action handling

- Design, build, and maintain public-facing REST and event-driven APIs exposing clinical data, quality metrics, care gaps, attribution data, and decision support content to partners and provider-facing applications

- Establish API contracts, versioning strategies, and deprecation policies that balance innovation with stability for external consumers

- Implement and maintain API security patterns including OAuth 2.0, scope-based authorization, rate limiting, and audit logging for compliant clinical data access

- Design and optimize real-time or near-real-time data pipelines feeding CDS Hooks and APIs—ensuring low latency, high freshness, and graceful failure modes

- Design and implement comprehensive testing and QA frameworks for CDS Hooks and APIs — including hook context validation, card rendering verification, and clinical workflow testing across EMR systems

- Establish reliability metrics and SLAs (latency, availability, freshness) for CDS Hook delivery and API performance; measure and track against clinical requirements

- Define and measure clinical impact metrics — adoption of CDS Hooks, clinician interaction rates, workflow integration success, and patient outcome influence

- Exercise architectural judgment across tradeoffs in correctness, latency, scalability, maintainability, and operational risk in clinical data systems

- Design and implement reliability patterns for CDS and API services including monitoring, alerting, failure detection, graceful degradation, and incident recovery

- Partner with Data Reliability Engineer to define and operate SLAs for CDS Hook delivery, API response times, and data freshness aligned to clinical needs

- Establish and uphold engineering standards for API design, data schemas, integration patterns, and interoperability; maintain high-quality technical documentation and OpenAPI specifications

- Partner with Data Engineering to align upstream data models, gold-layer datasets, and platform capabilities with clinical decision support and API requirements

- Serve as the technical authority on clinical interoperability standards (SMART CDS Hooks, FHIR, HL7, CDS Hooks, EHR integration patterns)

- Collaborate with Product, Clinical Operations, and Business stakeholders to clarify requirements, translate clinical workflows into platform features, and shape product direction

- Act as trusted technical advisor to EMR partners, healthcare systems, and external API consumers; ensure expectations and delivery are well-defined and predictable

- Ensure all CDS and API services comply with healthcare security, privacy, and regulatory requirements (HIPAA, state regulations, payer mandates)

- Partner with IT Security and Compliance teams to implement secure access controls, audit logging, encryption, and data protection measures across delivery mechanisms

- Design and implement audit trails for all clinical data access; support compliance audits and regulatory reporting

- Mentor team members through design reviews, pairing, and architectural guidance on clinical data integration and API design

- Document new and existing systems, designs, processes, and procedures

Required Qualifications
- 8+ years of experience designing, building, and operating API platforms, service-oriented systems, or backend infrastructure at scale

- Demonstrated experience operating at a senior or staff-level individual contributor scope, owning complex systems end-to-end

- 3+ years of direct experience with healthcare data integrations, EMR workflows, clinical data exchange, or healthcare interoperability standards (FHIR, HL7, CDA, claims data)

- 2+ years of hands-on experience with CDS Hooks, SMART on FHIR, or similar clinical decision support APIs

- Strong experience designing and operating REST APIs, including contract design, versioning, error handling, and authentication/authorization patterns

- Deep understanding of healthcare data integrations, EMR workflows, and interoperability patterns (FHIR, HL7, CDS Hooks, SMART on FHIR)

- Expertise in designing for reliability, SLAs, and operational metrics; ability to translate clinical requirements into technical SLOs

- Experience defining and measuring API performance metrics (latency, availability, error rates); familiarity with SLA monitoring and enforcement

- Strong systems thinking with ability to design for scale, reliability, maintainability, and resilience

- Proficiency in modern backend languages (Python, Java, Go, or similar); comfort reading and reviewing code across languages

- Experience with cloud platforms (AWS, Databricks, GCP) and containerized services (Docker, Kubernetes, or managed services)

- Proven ability to partner effectively across engineering, product, analytics, clinical operations, and business teams

- Clear written and verbal communication skills, particularly for explaining technical concepts and tradeoffs to clinicians and non-specialists

- Comfortable working in a fast-moving, ambiguous environment with healthcare compliance and regulatory constraints

Strong Pluses
- Hands-on experience with CDS Hooks specification and SMART on FHIR implementations in production healthcare environments

- Experience implementing and testing CDS Hooks across multiple EMR systems (Epic, NextGen, Athena, ECW) including clinical workflow validation

- Familiarity with healthcare data formats and standards: FHIR resources (Patient, Condition, Medication, etc.), CCD/C-CDA, claims data (837s, 835s), HL7 v2 or v3

- Experience designing and operating real-time or near-real-time data pipelines feeding clinical applications and decision support systems

- Knowledge of value-based care metrics, care gaps, quality measures (NQF, HEDIS), and HCC/RAF risk stratification

- Experience with API management platforms, developer portals, or partner ecosystem / API monetization patterns

- Familiarity with OAuth 2.0, OIDC, SAML, and federated identity patterns in healthcare systems

- Experience with CI/CD pipelines, infrastructure-as-code, and safe deployment practices

- Background supporting provider-facing platforms or external clinical partners; deep understanding of provider workflows and constraints

- Experience in a healthcare startup or high-growth healthcare techn