Senior .NET Engineer Healthcare Platform (C#/.NET, Node.js/TypeScript, Azure/AWS)

Responsibilities

• Write production code across backend services, including the least glamorous and highest-risk parts of the system
• Design and own multi-stage processing pipelines with durable state, checkpointing, resumability, and clean recovery from partial failure
• Build the deterministic harness around external and ML services: request orchestration/batching, strict payload validation, timeouts and retries, caching/deduplication, concurrency limits, cost and latency budgets, and defined degraded-mode behavior
• Keep vendor integrations behind provider-agnostic abstractions so services can be swapped without a rewrite
• Instrument end-to-end pipeline lineage so any output can be traced to its inputs, code version, and configuration - and reproduced on demand
• Set the testing and quality strategy for owned systems, including integration and contract tests
• Lead incident response and root-cause analysis for high-severity production issues; close the loop with durable fixes and better instrumentation
• Own observability: structured logging, business/process-health metrics, dashboards and alerting as code, meaningful SLOs
• Define infrastructure as code, deployment topology, and environment promotion; improve CI/CD throughput and safety (deployment gates, progressive rollout, feature flags)
• Partner with security on threat modeling and remediation of scanning findings
• Mentor senior and staff engineers; raise the code-review bar across teams, including stacks you don’t own
• Translate ambiguous product and clinical goals into scoped, sequenced technical plans; represent engineering reality to clinical and non-engineering stakeholders

Required Qualifications

• 10+ years of professional software engineering experience, with 3+ years at staff level or above (owning technical direction across multiple teams); equivalent demonstrated scope acceptable
• Depth in at least one modern backend ecosystem - TypeScript/Node.js or C#/.NET strongly preferred; strong Java, Go, or Python engineers who have picked up new stacks quickly are encouraged to apply
• Proven ownership of distributed, event-driven systems in production: messaging/queueing, idempotency, failure handling, long-running workflows
• Experience building reliable software on top of unreliable dependencies (slow, rate-limited, or unpredictable external services)
• Substantial hands-on experience with AWS or Azure: serverless compute, containers, managed relational databases, caching, secrets management, IAM, and infrastructure as code
• Strong relational data modeling and SQL, including schema and migration strategy for zero-downtime systems
• Working depth in modern web application architecture: component-based front ends (React/Next.js), server-side rendering, API design and versioning
• Excellent written technical communication - design docs, RFCs, and incident write-ups
• Experience in a regulated domain where being wrong has real consequences

Preferred Qualifications (strength in several, not all)

• Healthcare domain: FHIR, HL7v2, C-CDA, ICD-10, CPT, risk-adjustment coding; EMR/HIE integration; clinical document ingestion and OCR
• Workflow orchestration at scale: durable execution engines, saga/compensation patterns, strict lineage
• Production integration of ML/non-deterministic services: schema enforcement on model output, versioned prompts/config as deployable artifacts, cost/token budgeting, reproducible runs
• Multi-cloud or cloud-portable architecture; cross-cloud integration without lowest-common-denominator design
• Domain-driven design and clean/hexagonal architecture with automated boundary enforcement
• Observability engineering: custom metrics pipelines, distributed tracing, SLO practice
• Identity and access: OAuth 2.0/OIDC, managed IdP, token exchange, service-to-service auth, multi-tenant authorization
• Incremental modernization: strangler-pattern migrations, integrating with legacy systems
• HIPAA, SOC 2, or HITRUST program experience; SAST and container scanning
• Fluency with AI-assisted development tooling and a clear view on its place in a regulated workflow
• Experience standing up greenfield services alongside an existing platform without fragmenting it

Technical Environment

• Backend: TypeScript/Node.js, C#/.NET | Front end: React, Next.js
• Cloud: AWS and Azure - serverless functions, container services, managed Postgres, object storage, managed caching, IaC
• Data: PostgreSQL (primary), SQL Server, Redis-compatible caching
• Messaging: managed queue and pub/sub services on both clouds, including cross-cloud integration
• External services: managed ML inference and search behind provider-agnostic abstractions
• Delivery: Azure DevOps pipelines, containerized deploys, automated security scanning, feature flags