Principal Engineer
Legion HealthTelepsychiatry / company
San Francisco, United States$250,000 to $400,000Lead
Y Combinator
Alumni Ventures
ZD Ventures
Next Coast Ventures
Acequia Capital
Stone Mountain Ventures
Software EngineeringNew
About the role
TL;DR
Principal Engineer to own and build critical systems for an AI-driven healthcare platform.
- •Legion Health is building the AI infrastructure to deliver world-class healthcare, starting with autonomous medical care in psychiatry.
- •We are seeking a Principal Engineer to own critical systems within our care platform.
- •Key Responsibilities Own entire problem spaces from inception to completion, not just tickets.
- •Develop and maintain the factory spine for agentic engineering, scaling to 10,000 PRs per month.
- •Own the clinical work spine, ensuring auditability and fail-closed checks for AI agents and human actions.
- •Manage agent operations in production, expanding autonomy as proof accumulates.
- •Oversee the data and metrics estate, including warehouse, analytics platform, and pipelines.
- •Requirements Proven experience owning architecture across multiple companies or codebases (staff-plus IC, chief-architect, or platform-consulting background).
- •Experience shipping daily at high volume with a fleet of AI agents.
- •Instinct to take ownership of ambiguous, load-bearing problems.
- •Proactive written communication skills.
- •Commitment to clinical-grade correctness, including auditability, HIPAA, and fail-closed defaults.
Required skills
TypeScriptNode.jsPostgreSQLLLMsAWSGitLinuxREST APIGraphQLHIPAA
Nice-to-have skills
Next.js
Domain expertise
healthtechai
Benefits & perks
equity, Health Insurance, vision benefits, dental benefits, In-person retreats, meal stipends, unlimited vacation policy
Tech stack
TypeScriptNode.jsPostgreSQLNext.jsAWSLLMsGitLinuxREST APIGraphQL