Forward-Deployed Integrations Engineer

Reports to: Chief Technology Officer
Location: Burlington, VT (hybrid) or remote (no formal travel required)

Why this role exists

Every healthcare organization operates on a unique technology stack.

One EHR exposes a clean FHIR endpoint. Another has a vendor-specific API with its own authentication and rate limits. A third has no supported API at all for the scheduling, patient, or clinical data our product needs. Even practices on the same EHR configure it differently, enforce different security requirements, and run entirely different front-desk workflows.

OhMD still has to work.

Our products need accurate patient context, appointment data, and workflow state to resolve conversations safely. Our AI voice and text assistant cannot book, confirm, or reschedule an appointment it cannot see. Those integrations have to be reliable enough to support real patient interactions, secure enough to handle protected health information, and understandable enough that our customers trust what is happening.

Which brings us to the hard part, and to you.

This role owns the path between a practice's real-world workflow and a working production integration. You'll sit with customers, understand how their systems actually operate, choose the right integration approach, build it, test it, launch it, and stay with it until it works cleanly.

Today that footprint spans more than a dozen EHRs. Our deepest integrations are athenahealth, eClinicalWorks, DrChrono, Elation, and Healthie, and they run across three codebases: a .NET service that handles patient sync and chart write-back, an Elixir platform that handles scheduling and reminders, and a TypeScript and Playwright service for systems that don't offer a usable API. You won't need to be expert in all three on day one, but you will need to be comfortable reading and shipping in each.

Sometimes the right answer will be a vendor REST API or a FHIR application. Sometimes there will be no usable interface at all, and you'll build production-grade browser automation to retrieve the data OhMD needs.

This is not a role where you write a specification and hand it to someone else. You'll be the engineer in the customer conversation and the customer-facing owner in the code.
What your first 90 days look like

Weeks 1-4: Live in the product. Learn how OhMD connects to EHRs today, shadow customer discovery sessions and go-lives, and understand how patient, scheduling, and workflow data move through the platform. Get familiar with our integrations across EHRs.

Weeks 5-8: Own your first integration with support. Scope the customer's requirements, select the right technical path, build or configure the integration, validate the data, and support the customer through testing. Ship something that runs against a real production workflow.

Weeks 9-12: Lead an integration workstream independently. Own technical discovery, implementation, validation, launch, and early production support. Bring us a point of view on what should become a reusable connector, what belongs in shared infrastructure, and where our current approach will break at scale.
Essential Duties - What You'll Own
Customer integrations, start to finish

You'll work directly with healthcare organizations, EHR vendors, internal implementation teams, and engineering partners to understand what a customer needs and how their systems behave.

You'll translate operational workflows into concrete technical requirements, define what is and is not feasible, identify dependencies early, and own the integration through implementation, testing, go-live, and stabilization.

You will be expected to communicate clearly with both technical and nontechnical stakeholders. When a customer says, "We need OhMD to know whether this patient has an appointment," you'll determine where that information lives, how it can be accessed, how trustworthy it is, and what should happen when it is missing or wrong.
The right interface, not just the obvious one

You'll design, build, and troubleshoot integrations using REST APIs, webhooks, event-driven interfaces, file-based exchange, and vendor-specific integration methods.

You'll handle the details that determine whether an integration works outside a demo: authentication, authorization, OAuth 2.0, API keys, pagination, rate limits, idempotency, retries, data reconciliation, version changes, and partial failures.

You'll consume external APIs, design internal integration interfaces, troubleshoot undocumented customer behavior, and help define reusable patterns for how OhMD connects to third-party systems.
Healthcare interoperability that survives the real world

You'll build, map, validate, and troubleshoot integrations using FHIR R4, SMART on FHIR, and vendor-specific APIs, and you'll occasionally meet older FHIR versions and document formats like CDA along the way.

You'll investigate unexpected values, missing identifiers, duplicate records, patient-matching problems, incomplete mappings, delayed events, and the many other ways healthcare data refuses to behave like the specification says it should.
Browser automation as production integration infrastructure

When an EHR or healthcare system does not expose a usable API, you'll build robotic process automation using Playwright.

These automations will retrieve data from web-based EHRs and administrative portals in a controlled, secure, and auditable way. You'll design them as production software-not disposable scripts.

That means resilient selectors, session and credential management, safe handling of authentication flows, deterministic navigation, structured data extraction, validation, logging, retries, timeouts, failure recovery, alerting, and clear operational ownership.

You'll know that a browser workflow working once is not the same thing as an integration working every day.
Data mapping and transformation

You'll transform inconsistent source data into stable models the OhMD product can rely on.

You'll work with patient demographics, appointment data, booking, confirmation, provider and location information, communication preferences, refill-related context, and other workflow data. You'll define mappings, validation rules, fallback behavior, and reconciliation processes.

When two systems disagree, you'll help determine which source should be authoritative and make the resulting behavior explicit.
Practice go-lives and production quality

You'll own the technical integration workstream during customer implementations.

You'll create test plans, validate data with customers, diagnose issues across system boundaries, and make go-live decisions based on evidence rather than optimism. You'll build automated tests and validation tools that catch failures before a practice or patient does.

After launch, you'll monitor integration health, investigate production issues, and build the logging, alerts, retries, reconciliation, and recovery mechanisms needed to keep integrations reliable.
Security and patient trust

You'll work with protected health information and systems that directly affect patient workflows.

You'll apply least-privilege access, secure credential handling, encryption, appropriate audit logging, and careful data-retention practices. You'll partner with security and compliance stakeholders to ensure integrations meet OhMD's obligations and customer requirements.

You'll treat reliability and security as product behavior, not administrative work added at the end.
Patterns that outlive you

The first time we solve an integration problem, it may be a customer project. By the fifth time, it should be a reusable capability.

You'll identify common data models, authentication patterns, browser workflows, validation rules, and implementation steps that should graduate into shared connectors, libraries, templates, and internal tools.

You'll document what you build so another engineer or implementation partner can operate it without reconstructing the reasoning from scratch.
A tight feedback loop with product and engineering

You'll work across engineering, product, implementation, customer success, support, and security.

When an integration exposes a platform limitation, you'll define the problem clearly and help determine whether the answer belongs in a customer-specific implementation, a reusable integration component, or the core product.

You'll influence the roadmap without waiting for every problem to become someone else's ticket.
Non-Essential Duties
Helping improve our integration practice

You may contribute to integration architecture standards, internal documentation, implementation playbooks, developer tooling, and technical training for adjacent teams.
Helping build the team

You may participate in interviews and onboarding for future integration, implementation, and engineering hires as the team grows.
Representing the work

You may occasionally participate in customer webinars, remote partner sessions, or technical discussions with EHR and technology partners.

Other duties as assigned.
Qualifications
Required

5+ years of relevant experience. You have at least five years of experience in software engineering, integration engineering, solutions engineering, healthcare interoperability, or another hands-on technical role in which you owned integrations through production.

Production software engineering skills. You can design, build, test, deploy, and troubleshoot production systems. You are highly proficient in TypeScript and comfortable reading and shipping in C# and Elixir, or confident you can get there quickly. You use SQL to inspect and validate data.

API depth. You have hands-on experience consuming, designing, and troubleshooting REST APIs, webhooks, JSON, XML, authentication systems, OAuth 2.0, API keys, pagination, rate limits, and versioned interfaces.

FHIR experience. You have built or supported production healthcare integrations using FHIR. You can read resources and bundles directly, reason about mappings, diagnose failures, and communicate with EHR interface teams without needing an intermediary.

Robotic process automation experience. You have built and operated browser automation with Playwright or a comparable tool. You understand the operational risks of browser-based integrations and know how to make them supportable.

Customer-facing ownership. You are comfortable leading technical discovery, explaining tradeoffs, setting expectations, navigating ambiguity, and working directly with customer IT teams, interface analysts, operational leaders, and external vendors.

EHR integration experience. You have worked with one or more major ambulatory or enterprise EHR platforms. Experience with athenahealth, eClinicalWorks, DrChrono, Elation, and Healthie is particularly relevant.

Rigor with real systems and real data. You find out whether something works by building and testing it, reading logs and tracing requests rather than trusting the documentation. You validate mappings, catch mismatched identifiers and duplicates, and know that a successful API call is not the same as a correct business outcome. You handle PHI, credentials, and access to clinical systems with least privilege and auditability by default.

Clear communication. You can explain technical constraints in plain language, write useful implementation documentation, and communicate confidently with both engineers and healthcare operators.

Care about the end user. The data moving through these integrations affects real patient conversations. Accuracy, reliability, and graceful failure should matter to you.
Preferred

• Direct integration experience with multiple systems among athenahealth, eClinicalWorks, DrChrono, Elation, and Healthie
• Experience with queues, event-driven architectures, background jobs, and distributed systems
• Experience with cloud infrastructure, containers, CI/CD pipelines, secrets management, and infrastructure-as-code
• Experience building reusable connector frameworks or integration platforms
• Experience with patient scheduling, registration, messaging, referral, or refill workflows
• Experience working in an early-stage or rapidly scaling software company
• Experience in a forward-deployed, solutions engineering, or technical implementation role
• Relevant EHR vendor certifications or participation in EHR developer and partner programs

Pay range

$154,975-$192,553 USD