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Salary: USD 250,000 - 400,000 / annual
Legion Health is building autonomous medical care powered by AI, starting with psychiatry. The company has received regulatory authorization to let AI prescribe psychiatric medications—a first-of-its-kind achievement. Legion operates an AI-native care-delivery platform that automates 95% of administrative work and has delivered tens of thousands of patient visits in just two years while maintaining flat operational costs and industry-leading patient NPS and retention.
You will join as a principal-level engineer reporting to Daniel G Wilson, co-founder and CTO (Princeton-trained in applied math and CS, formerly at Microsoft leading Office Scripts and Power Automate integration). This is a whole-domain ownership role: you will take on entire problem spaces from "this is a mess" to "this is done and documented," without waiting for scoped tickets or mediation.
You will own one or more of these core systems:
- The factory spine: architecting maximum leverage in agentic engineering. Legion ships 500–1,000 PRs monthly with a lean team. You will scale merge gates, migration safety, canary and rollback mechanisms to support 10,000 PRs/month while maintaining quality and rigor on a system where bad deploys touch patient care.
- The clinical work spine: an event-sourced system of record for clinical work (orders, tasks, commands, receipts) that enables AI agents and humans to act on patient care with auditability and fail-closed checks. You will own guardrails ensuring agents can safely expand their scope of care delivery.
- Agent operations in production: LLM agents performing real clinical-adjacent work with tool use, checks, and receipts. You will decide how autonomy expands as proof accumulates, including the agent harness that prescribes psychiatric medication legally.
- The data and metrics estate: warehouse, analytics platform, and pipelines that surface what actually happened.
- Architecture syncs with the CTO: you will have standing to disagree, make calls in your domain, and unpack decisions for the team.
The company is backed by Y Combinator and leading venture capital firms. It has raised $23M+, achieved $5M+ ARR, and is two years into operations.
Tech stack: TypeScript, Node.js, Postgres, Next.js on Vercel, AWS, production LLM agent orchestration, bespoke harnesses, tools, CLIs, skills, evals and observability, EHR and e-prescribing integrations, PHI-grade security and audit trails.
Work setup is in-person at San Francisco HQ; partial remote considered for exceptional candidates. Work hours are flexible but demanding—the company is literally saving lives. You will have autonomy over projects, freedom to set priorities, shape processes, and drive outcomes end-to-end. As the company scales, top performers are envisioned stepping into expanded roles and executive leadership.
REQUIREMENTS:
- You have owned architecture across multiple companies or many codebases: staff-plus IC, chief-architect, or platform-consulting background. You have seen a dozen ways teams ship and hold opinions with scars behind them.
- You ship daily at high volume with a fleet of AI agents. This is table stakes. You can demonstrate your actual setup and what you let it do unsupervised. ("I use Copilot sometimes" does not meet this bar.)
- When handed an ambiguous, ugly, load-bearing problem, your instinct is to take it whole: read everything, decide, build, write the doc, tell the team what you decided. You do not schedule meetings about scope.
- You communicate proactively in writing. The pattern valued: 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 compliance, fail-closed defaults, invariants over vibes.
- Typically 10+ years of experience and multiple systems owned end-to-end, but the company cares about the scars, not the number.
- This is not the role if you want to manage instead of build, need well-scoped tickets to be productive, or prefer big-company pace.
