Staff Software Engineer

Iterative Health is a healthcare technology and services company powering the acceleration of clinical research to transform patient outcomes.

We built a leading performance-driven network of 100+ sites across the US, Europe, India, and Australia, conducting research directly in the communities where care is delivered across gastrointestinal, hepatology, obesity, and cardiology. By combining deep clinical trial expertise with cutting-edge AI, we connect sponsors' scientific ambitions with high-performing research teams that expedite and expand access to novel therapeutics for patients in need. Today, Iterative Health is headquartered in Cambridge, Massachusetts, and New York City with 250+ employees world-wide.

About the Role

Accelerating clinical research is one of the defining challenges in healthcare. Promising therapies exist that patients can't access because the operational infrastructure to run clinical trials efficiently doesn't exist yet. We're building it. That means designing technology systems that bring order to a fragmented landscape of clinical data sources, automating the operational work that slows trials down, and turning real-world clinical data into a foundation for predictive intelligence.

We're looking for a Staff Software Engineer to own the design and implementation of the core systems that make this possible. This means building robust integrations across a complex, fragmented landscape of EHRs, CTMS platforms, and clinical data sources, each with its own data models, access patterns, and operational constraints. It also means building the data infrastructure that powers our predictive capabilities: the pipelines, feature stores, and training infrastructure that allow us to move from raw clinical data to models that meaningfully improve trial execution. This is a generalist role for someone who thinks in systems. You'll move between architecture and implementation, between integration engineering and ML infrastructure, between defining technical strategy and writing the code that proves it out. The problems are genuinely hard, largely unsolved, and what you build will matter.

This is an opportunity for someone who wants to be a part of a small, fast moving engineering team at a formative stage. You'll shape what gets built, how decisions get made, and what the team becomes.

Responsibilities

• Own the technical architecture for our core systems and build the foundational abstractions and interfaces that everything else is built on top of
• Build reliable integrations with dozens of external clinical data systems (EHRs, CTMS, eSource, labs), treating this as a hard systems design problem, not just an ingestion problem
• Build and evolve the infrastructure that supports model training and predictive capabilities, from ingestion through feature engineering and serving
• Move fast by prototyping to drive experimentation; derisk ideas quickly to keep the team building what works
• Evaluate and choose the technologies we build on: make build vs. buy decisions, select vendors, and shape our long-term infrastructure strategy
• Make the key technical tradeoffs between speed and durability, between generality and shipping
• Work across product, clinical operations, and data science to make sure you're solving the right problems, not just the interesting ones
• Help shape the engineering culture of a small, growing team: how technical decisions get made, how problems get debated, what rigor looks like in practice

What We're Looking For

Required Qualifications

• Have 10+ years of software engineering experience, with significant time spent designing and building systems not just features
• Experience with healthcare data systems (HL7, FHIR, EHR/EMR integrations) or other highly regulated data environments
• Have 2+ years experience working in a high-growth startup environment
• Have deep experience with system integration, particularly across unreliable or heterogeneous external data sources
• Can think through and explain the full picture of a complex system while still being effective at the implementation level
• Experience using AI tooling and frameworks as part of your engineering workflow
• Have built data pipelines and infrastructure that support analytical or ML workloads in production
• Strong across the backend stack (Python, SQL, cloud infrastructure) and can pick up new tools and systems quickly
• Have built systems from early stages, making foundational decisions with incomplete information, not just extending established infrastructure
• Naturally raise the quality of the engineering around you through code review, architecture guidance, and honest technical conversation

Preferred Qualifications

• Experience building ML training infrastructure or feature platforms
• Familiarity with clinical operations, systems, or life sciences data
• SOC 2, HIPAA or similar compliance experience baked into engineering practice
• A track record of building systems that had to work correctly under real operational constraints, scale and complexity

New York pay range

$180,000-$250,000 USD

At Iterative Health, we're actively working towards creating an environment that is representative of the diversity of patients our technology serves. We are focused on building an equitable and inclusive culture, and by extension, hiring process. If you require any accommodations to make the application process or interviewing experience more accessible to you, please contact View email address on click.appcast.io.