Synthesis Health

Who We Are

We’re a mission- and values-driven company with tremendous dedication to our customers. Our 100% remote team is dedicated to a common goal – to revolutionize healthcare through innovation, collaboration, and commitment to our core values and behaviors.

About the Opportunity

We are looking for a Principal Platform Engineer to serve as a hands-on architect of our system’s evolution. In this role, you will tackle our most substantial engineering challenges: ensuring the reliability, performance, and scalability of our distributed systems while driving the maturation of our technical stack.

This is a leadership role for a hands-on technical visionary. You will focus on solving deep, structural problems in the overall system to achieve 99.99% reliability and massive scalability. You will drive key maturation issues regarding our architecture, identifying the critical path for eliminating bottlenecks, reducing complexity, and enabling our engineering teams to ship faster with greater confidence. As a key voice on the Architecture Review Board (ARB), you will shape the technical direction of the entire organization.

If you are an expert in high-scale distributed systems and have the scars and success stories to prove it, this is your chance to build a legacy.

Key Responsibilities

System Reliability, Performance, & Scalability

• Solve Substantial System Challenges: You will identify and lead the resolution of the most complex, systemic problems affecting our platform's stability and speed.
• Architect for Scale: You will design the strategies that allow our system to handle exponential growth, focusing on database scaling, caching architectures, and asynchronous processing throughput.
• Reliability Engineering: You will define and drive the adoption of patterns that ensure system resilience, including circuit breaking, graceful degradation, and active-active failover strategies.

Stack & Architecture Maturation

• Drive Technical Evolution: You will lead the maturation of our technical stack, ensuring our libraries, frameworks, and infrastructure choices evolve to meet future business needs.
• Eliminate Structural Bottlenecks: You will look beyond code-level optimization to solve structural issues in our database layer, messaging infrastructure, and deployment pipeline.
• Technical Governance: As a senior leader on the ARB, you will enforce architectural rigor, preventing the introduction of new technical debt while establishing standards for long-term maintainability.

Strategic Leadership & Influence

• Cross-Organizational Impact: You will influence the technical direction across multiple product areas, reconciling conflicting architectural goals to serve the broader business.
• Elevate the Platform: You will mentor Staff and Senior engineers, helping them understand distributed consensus, eventual consistency, and the trade-offs of complex distributed systems.

What We’re Looking For

• Elite Distributed Systems Experience: 10+ years of software engineering experience, with a heavy focus on designing, optimizing, and operating high-scale distributed systems.
• Architectural Evolution: You have a proven track record of evolving complex systems and driving technical maturity in a fast-paced environment.
• Language Fluency & Strategy: Deep expertise in TypeScript/Node.js is required. As we pivot performance-critical paths toward Go, experience leading similar language transitions or strong Go proficiency is highly desirable.
• Deep Technical Mastery:
  • Expertise in defining Service Level Objectives (SLOs) and Error Budgets.
  • Deep knowledge of synchronous (Websockets, gRPC, REST) vs. asynchronous (Kafka/PubSub) communication patterns.
  • Advanced database design patterns (sharding, partitioning, CQRS).
  • Expertise in container orchestration (Kubernetes) at scale.
• Visionary Leadership: You can identify critical long-term technical challenges months or years in advance and mobilize the organization to address them.
• Communication at Scale: You can effectively communicate the business value of architectural investments to executive leadership while diving deep into the code with engineers.

Preferred Qualifications

• Healthcare Domain Experience: Experience in healhtech or regulated industries is a plus.
• Compliance & Standards: Deep familiarity with healthcare data standards (DICOM, HL7, FHIR) and compliance regulations (HIPAA) is a significant advantage.
• High-Performance Database Tuning: Deep experience tuning PostgreSQL or similar relational databases for massive concurrency.
• Breaking Up The Monolith: Experience migrating a monolithic database architecture to microservices is a plus.

Why You Should Join Us

• Solve Our Toughest Puzzles: This is a high-leverage role. You will be working on the most impactful technical challenges that are critical to the company's success.
• Define the Architecture: You won't just be maintaining a system; you will be a primary author of its future state, with the autonomy to make it happen.
• Lead from the Front: This is a chance to establish yourself as a key technical voice in a rapidly growing company.
• Competitive Compensation & Benefits: We offer a strong salary, meaningful equity, a 100% remote culture, and significant opportunities for growth.

We are a values-driven company. Our values:

• Clinical service first.
• Collaborate with our customers.
• Listen, respect, learn.
• Innovate to excel.

The behaviors we look for:

• Be nice.
• Be creative.
• Be honest.
• Be helpful.

Compensation and Benefits

Typical salary range for this position is $170,000 - $205,000. However, Synthesis participates in location based hiring and salary ranges can be adjusted based on candidate's residence. 

Other benefits include, but are not limited to: Medical, Dental, Vision, “Use as needed” vacation policy, and participation in our employee option program.

Synthesis Health is an Equal Employment/Affirmative Action employer. We do not discriminate in hiring on the basis of sex, gender identity, sexual orientation, race, color, religious creed, national origin, physical or mental disability, protected veteran status, or any other characteristic protected by federal, state, or local law.