---
title: 'Principal Software Engineer at Foundation Health'
canonical: 'https://feeny.ai/job/principal-software-engineer-foundation-health-united-states-czta08s0gp6f'
type: 'job'
last_seen: '2026-11-02'
---

# Principal Software Engineer at Foundation Health

- **Company:** Foundation Health
- **Location:** United States
- **Employment:** full-time
- **Work type:** remote
- **Posted:** 2026-10-09
- **Last confirmed live:** 2026-11-02
- **Apply:** https://jobs.ashbyhq.com/foundationhealthcareers/b15b067e-9b67-466c-9e95-0be14f43ce9a

## Job description

## About Foundation Health

Foundation Health is an AI operating system for pharmacy - built by a team who lived the problem firsthand, not one that came to healthcare from the outside. Every day, prior authorizations delay prescriptions, pharmacists lose hours to paperwork instead of patients, and prescriptions slip through the cracks between health systems. We believe thoughtfully applied AI can finally change that - deep, integrated infrastructure that streamlines how care is coordinated, purpose-built for the complexity of specialty pharmacy.

We're building toward a world where pharmacy teams spend their time on patients, not paperwork - where AI handles the routine so clinicians can focus on what only humans can do. Getting there takes the right people. We're looking for curious, ambitious folks who want to help solve healthcare's hardest problems - for our patients, our partners, and each other.

## The Role

This isn’t a pitch deck. Our platform is live in production inside major US health systems. Our AI handles real patient communication over voice and SMS and plugs directly into Epic workflows. If it gets something wrong, there’s no funny screenshot: a real person doesn’t get their medication. That’s the standard we build to.

You’ll own architecture across several product areas and design systems that can grow 10–100x without a rewrite. When the hardest problem in the company comes up, you’re the one who opens the editor and builds the first version.

You’ll also make the rest of engineering better. That means mentoring, leading projects across teams, and changing how we build, including how we use AI to ship faster without shipping worse. If you’ve already rolled out agentic dev practices at a team or company level and can show what happened to output and quality, we’d love to hear about it.

You’ll work directly with our VP of Engineering (ex-DeepMind) and CEO. Nobody here manages from a distance, at any level, and that includes the Principal.

The problems you’d own

- Agentic AI that’s safe to put in front of patients. This covers voice and SMS agents, plus the evals, guardrails, red teaming and pharmacist-oversight design that make them trustworthy. If you’ve worked on AI safety or LLM security in production, this is where that experience pays off.
- Deep EHR integration. Epic queues, prior authorization automation and 340B compliance, where correctness really matters and the specs are older than some of our engineers.
- Our target-state architecture. You’ll take the platform from a handful of health systems to hundreds and build the first mile of that migration yourself.
- How we do AI engineering. That includes model selection, context management, cost and latency tradeoffs, and evaluation methodology.

Who tends to do well here

- You’ve built serious systems with your own hands recently, and you can go deep on the details of anything you’ve shipped. Your title doesn’t matter much. Plenty of great Principals have spent time as directors or heads of something without ever stopping building.
- You’ve worked at Staff+ level somewhere with a high bar, and you can point to architectural decisions a company still runs on.
- You’ve built with LLMs in production, well beyond SDK calls: agents, tool use, evals, guardrails, and the unglamorous work of making them reliable.
- You keep things as simple as the problem allows. You’d sooner run a well-structured monolith on Postgres than ten microservices nobody can debug, and you change the architecture when real constraints show up, not before.
- You’ve worked somewhere mistakes are expensive. That could be healthcare, but fintech, fraud, trust and safety, or anywhere compliance shapes design counts too. We don’t need you to know healthcare yet. We need you to care about getting it right.
- You find the highest-leverage problem in the company and solve it without waiting to be pointed at it.

Where we are We’re about 70 people, past product-market fit, raised a $20M Series A led by Define Ventures, and our CEO is a 2x founder.

The practical stuff We’re remote-first across the US, with an engineering hub in downtown Orlando that you’d visit from time to time. We’d ideally like you on Eastern or Central time, since a good chunk of our engineering team is in the UK and the overlap really helps. And it’s early enough that the equity is founding-role equity, not a rounding error.

## About Foundation Health

## Company Overview
- **One-liner**: Foundation Health provides an AI-powered operating system for pharmacy and digital healthcare, automating workflows for prior authorization, refills, and patient communication.
- **Entity Type**: Private (Series A)
- **Headquarters**: Menlo Park, California, United States
- **Founded**: 2023
- **Founders**: Umar Afridi (CEO & Founder)

## Core Business
- **Primary industry**: Healthcare technology / Digital pharmacy / Prior authorization automation
- **Target customers**: Health systems, health plans/insurers, pharmaceutical manufacturers, consumer health companies (B2B, enterprise)
- **Mission / purpose**: “Delivering the future of digital healthcare” – modernizing healthcare by reducing administrative friction so clinicians can focus on patient care.

## Products & Services
- **PAIGE (AI Operating System for Pharmacy)**: An AI assistant that automates repetitive pharmacy tasks such as prior authorization, refill authorization, 340B compliance audits, and patient communication. Includes workflow orchestration, task tracking, and exception management.
- **Digital Front Door**: White-labeled patient-facing interface for managing specialty and retail prescriptions, auto-refills, prescription transfers, copay payments, and delivery tracking.
- **Prior Authorization Automation**: End-to-end automation including benefits investigation, eligibility checks, test claims, generation of draft responses to payer questions, and auto-generated appeal letters for denials.
- **Refill Authorization**: Accelerates refill workflows under Collaborative Practice Agreements with AI pre-screening and pharmacist oversight.
- **340B Optimization**: Automates compliance audits by integrating TPA and EHR data to maximize eligible capture and recapture revenue.
- **Financial Assistance**: Identifies eligible patients for manufacturer copay coupons, quick start programs, and patient assistance foundations, then automates enrollment workflows.
- **MSOT Queue Automation**: Integrates with EPIC MSOT queue to automate manual workflows and expedite specialty prescription routing.
- **Patient Communication (SMS & VoiceAI)**: Automated outreach for patient assessments, adherence, and delivery coordination, with responses routed back into pharmacy workflows.
- **Pharmacy API**: Developer-first API for integrating telehealth, pharmacy, and diagnostics, handling compliance, logistics, and provider networks.

## Market Standing
- **Valuation**: Not publicly available (last funding round was Series A)
- **Key Metric**: Total raised $26M (Series A of $20M raised approximately 8 months ago as of mid-2025)
- **Notable Investors/Partners**: Not publicly disclosed; the company emphasizes its team’s experience (built the first Pharmacy API and operated nationwide pharmacies, physician clinics, and diagnostic centers across the US and Europe)
- **Growth Signals**: Founded in 2023, raised $26M in Series A; serving over 100 brands, shipping 20M+ prescriptions, serving 2M+ patients; mentions partnerships with leading health systems (e.g., Intermountain Health)

## Competitive Advantages
- **AI‑first platform purpose‑built for pharmacy workflows** – reduces prior authorization time by 50%, increases refill authorization throughput 2× per FTE.
- **Compliance built‑in** – HIPAA compliant and SOC 2 Type 2 certified, reducing risk for enterprise customers.
- **Full‑stack healthcare experience** – team has built and operated digital pharmacies, telehealth, and diagnostic services for Fortune 500 companies, plus physical pharmacies and clinics in the US and Europe.
- **Developer‑friendly API** – first‑in‑kind Pharmacy API that allows partners to ship compliant healthcare experiences quickly.
- **White‑label digital front door** – preserves health system brand while centralizing prescription management for patients.

## Strategic Focus
- Expand the AI operating system to cover additional pharmacy and payer workflows (denials, appeals, adherence).
- Deepen integrations with major EHRs (EPIC) and pharmacy management systems.
- Grow partnerships with health systems, health plans, and pharmaceutical manufacturers to drive adoption of the platform.
- Continue scaling the Developer API to enable third‑party innovation in digital pharmacy.

## Why Work Here
- **Remote‑first culture** – “Work from anywhere and thrive in a flexible, digital‑first environment.”
- **Generous PTO** and flexible working hours.
- **Comprehensive health, dental, and vision** coverage.
- **Employee stock option program** – invest in growth and share in the company’s success.
- **Meaningful impact** – directly reduce administrative burden for pharmacists and improve patient access to therapy.
- **Engineering culture** – the team built the first Pharmacy API; developers work on a compliance‑focused, API‑driven platform serving millions of patients.

## Sources
1. [foundationhealth.com](https://www.foundationhealth.com/)
2. [foundationhealth.com/about](https://www.foundationhealth.com/about)
3. [foundationhealth.com/careers](https://www.foundationhealth.com/careers)
4. [jobs.ashbyhq.com](https://jobs.ashbyhq.com/foundationhealthcareers)
5. [cbinsights.com](https://www.cbinsights.com/company/foundation-health)

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