Principal Engineer (backed by Y Combinator, $5M+ ARR, $23M+ raised)
Legion Health · San Francisco, CA · 2 days ago
On-siteEngineering$250k–$400k/yrFull-time
The role
Hey, I'm Daniel G Wilson, co-founder and CTO at Legion. I studied applied math and CS at Princeton, led the Office Scripts and Power Automate integration at Microsoft, and did deep learning and RL research before that. GitHub: https://github.com/danielgwilson
I'm hiring a principal-level engineer to own the hardest systems in our care platform, whole. Not tickets, not a lane inside someone else's architecture: entire problem spaces, from "this is a mess" to "this is done and here's the doc."
What you'll own
- The factory spine. Own the question of how we get maximum leverage in the era of agentic engineering. We ship 500–1,000 PRs a month with a lean team. Merge gates, migration safety, canary and rollback on a system where a bad deploy can touch patient care—this all works today. Your job will be to move us towards 10,000 while maintaining quality and rigor.
- The clinical work spine. Our event-sourced system of record for clinical work (orders, tasks, commands, receipts): the layer that lets AI agents and humans act on patient care with auditability and fail-closed checks. You’ll own the guardrails that ensure agents can safely provide broader and broader components of care.
- Agent operations in production. LLM agents doing real clinical-adjacent work with tool use, checks, and receipts. You decide how autonomy expands and ratchets upwards as proof accumulates. Your agent harness will help prescribe psychiatric medication, legally, at the second company ever allowed to.
- The data and metrics estate. Warehouse, analytics platform, and the pipelines that tell us what actually happened. Architecture syncs with me. You'll have the standing I give someone who has seen more systems than I have: disagree with me, make the call in your domain, unpack it for the team when asked.
What "a fit" looks like, concretely
- You've owned architecture across multiple companies or many codebases: staff-plus IC, chief-architect, or platform-consulting background.
- You've seen a dozen ways teams ship and you have opinions with scars behind them.
- You ship daily at high volume with a fleet of AI agents.
- You communicate proactively in writing. The pattern we love: a Sunday text that says "took care of it, here's the PR and what I changed."
- You hold clinical-grade correctness without losing speed: auditability, HIPAA, fail-closed defaults, invariants over vibes.
Tech Stack
- TypeScript, Node.js, Postgres, Next.js on Vercel, AWS
- production LLM agent orchestration and bespoke harnesses, tools, CLIs, skills, evals and observability
- EHR and e-prescribing integrations, PHI-grade security and audit trails
Process
- Coffee chat (20 min)
- Systems deep dive (60 min)
- Take-home (async)
- [Alternate] Paid work trial (2 to 5 days, flexible around your current job)
Role Logistics, Compensation, And Benefits
- Job type: Full-time
- Role type: Engineering
- US Visa Sponsorship: Yes
- Salary: $250,000 to $400,000 depending on experience, plus meaningful early-stage equity
- Health Insurance: Medical, dental, and vision benefits
- Additional Perks: In-person retreats, meal stipends, etc.
- Time Off: Flexible, unlimited vacation policy
- Work hours: flexible but demanding—because we are (literally) saving lives.
- Work Setup: In-person @ San Francisco HQ; partial remote considered for exceptional candidates (our track record includes both).
- Impact: Work on something that truly matters to millions of patients and families.
- Autonomy and Learning: Ownership over your projects with the freedom to set priorities, shape processes, and drive outcomes end-to-end.
- Growth Opportunities: As we scale, we envision our top performers stepping into expanded roles and joining our executive leadership team.