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 technology environment
Familiarity with healthcare data governance, interoperability regulations (21st Century Cures, ONC rules), and clinical data quality frameworks
Experience with API testing frameworks and quality assurance for distributed systems
Perks/Benefits
Competitive base compensation
Annual bonus potential
Health benefits effective on start date
Health & Wellness Program; up to $300 per quarter for your overall well-being available on start date
401K plan effective on the first of the month after your start date; 100% of up to 4% of your annual salary
Unlimited (or generous) paid "Vytal Time", and 5 paid sick days after your first 90 days
Company paid STD/LTD
Technology setup
Ability to help build a market leader in value-based healthcare at a rapidly growing organization
Please note at no time during our screening, interview, or selection process do we ask for additional personal information (beyond your resume) or account/financial information. We will also never ask for you to purchase anything; nor will we ever interview you via text message. Any communication received from a Vytalize Health recruiter during your screening, interviewing, or selection process will come from an email ending in @vytalizehealth.com