Senior Backend / Infrastructure Engineer

Role Description

The Backend/Infrastructure Engineer is the internal authority on the FHIR R4 data layer, HealthLake, and the AWS health services stack. This person owns the data architecture that every agent, every frontend feature, and every integration depends on. They review KMS's infrastructure work with authority, own the Supabase-to-HealthLake migration path, and ensure that every byte of PHI is stored, transmitted, and queried in compliance with HIPAA. This is the foundational engineering hire — if the data layer is wrong, nothing else works.

Job Activities and Responsibilities

• Own the FHIR R4 data model design — resource profiling, extensions, search parameters, and terminology bindings for the GLP-1 clinical domain
• Architect and implement the HealthLake data layer including ingest pipelines, FHIR API configuration, and query optimization
• Lead the Supabase-to-HealthLake migration — mapping the existing 100+ table schema to FHIR resources, handling data normalization (free-text drug fields, lab values), and ensuring zero data loss during transition
• Design and enforce encryption patterns (at rest, in transit, field-level where required) and PHI access controls across all data stores
• Review and approve KMS infrastructure code (Terraform/CDK) — serve as the technical authority on AWS service configuration and IAM policies
• Build the data access layer consumed by agents (Clinical Protocol, Pharmacy Fulfillment) and the Canvas frontend
• Implement audit logging infrastructure that satisfies HIPAA access tracking requirements and replaces the current manual archiving pattern
• Design Clean Rooms configurations for analytics use cases that require de-identified data access

Qualifications

• 7+ years in backend engineering with 3+ years focused on healthcare data infrastructure or interoperability
• Deep FHIR R4 expertise — must have designed FHIR resource profiles, implemented FHIR servers or worked extensively with FHIR APIs, and understand the difference between profiling decisions that help and those that create technical debt
• Strong AWS experience — HealthLake, Lambda, Step Functions, DynamoDB, S3, IAM, KMS. Must be comfortable owning production AWS infrastructure in a HIPAA-regulated environment
• Production experience with data migration from non-FHIR systems to FHIR — schema mapping, terminology normalization, and data validation pipelines
• Deep understanding of HIPAA technical safeguards — encryption, access controls, audit logging, minimum necessary standard, and BAA implications for service selection
• Strong SQL and API design skills — comfortable with both relational and document-oriented data patterns
• Experience working with outsourced development teams in a review/oversight capacity

Preferred Qualifications

• Experience with pharmacy data standards (NCPDP, RxNorm, NDC codes) and medication-related FHIR resources (MedicationRequest, MedicationDispense, MedicationKnowledge)
• Familiarity with AWS Clean Rooms, HealthLake analytics queries, or Athena for healthcare analytics
• Experience with Bedrock or other LLM platforms for building data retrieval layers (RAG patterns, vector search)
• Prior work with Supabase or PostgreSQL in healthcare contexts
• Experience with SMART on FHIR, CDS Hooks, or other clinical decision support integration patterns

Physical Requirements

• Proficient in using a computer and related equipment, including printers and fax machines.
• Ability to sit or stand for extended periods.
• Effective communication skills via telephone and email.
• Capable of lifting up to 40 pounds as needed.

Benefits

• Health care insurance (medical, dental, vision)
• Life Insurance
• Supplemental Insurance
• PTO
• 401K matching
• Sick leave
• Phone/internet reimbursement
• Remote work
• Top of the line machines