Substrate Engineer Jobs in Missouri (NOW HIRING)

At Commure, we’re building the AI Operating System for healthcare, the foundation that defines how care is delivered, documented, and financed. Our platform spans the full care journey: Ambient AI and Dictation eliminating documentation burden at the point of care, intelligent Agents automating patient and revenue workflows, and autonomous RCM processing billions in claims, all on a single AI-native platform integrated with 60+ EHRs.

Healthcare carries a $1 trillion administrative burden and we’re at the center of transforming it. Today, 500,000+ clinicians across 500+ healthcare organizations nationwide trust Commure to handle $25B+ in annual claims and support over 200 million patient interactions. Our latest $70M raise at a $7B valuation reflects the confidence the market has placed in this mission. We’ve also been named to the Fortune Future 50 list and the 2026 AI Breakthrough Awards for “Overall NLP Company of the Year.”

Our team works directly alongside clinicians, not through layers of process, which means the gap between what you build and its impact on patient care is immediate. We move fast, deploy daily, and take full ownership from early thinking to production. If you’re energized by hard problems, high stakes, and a team that holds itself to a high bar, you’ll find your people here.

The future of healthcare is being built right now. Come deliver this transformation.

The Data Integrations team owns the systems that move clinical and financial data between Commure and hundreds of external healthcare endpoints. The domain is EMRs, but the engineering problem is distributed systems at scale: durable orchestration on Temporal, strong delivery semantics against unreliable third parties, and a data and networking substrate that has to keep up as the business grows.

We’re looking for a Staff Software Engineer to set technical direction for this platform and help us scale as we move more towards Enterprise Customers.

• Set the technical direction for the platform. Decide what we build and how we execute.
• Own the architecture of the systems that move data through our platform, the orchestration layer, the pipelines, the data stores, and evolve them as scale.
• Look ahead. Anticipate the scaling and reliability walls we’ll hit two and four quarters out, and get in front of them before they become incidents.
• Set the bar for observability and operational readiness (monitoring, logging, distributed tracing, dashboards, alerting, SLOs, and safe production rollouts) and make sure the team actually lives by it.
• Work hand-in-hand with platform and product teams to keep sensitive customer data protected, tighten security boundaries, and stay on top of our regulatory and compliance obligations.
• Own complex, cross-system initiatives end to end: architecture and design, implementation, migration, rollout, and everything that comes with running it in production.
• Make pragmatic calls that weigh security, correctness, reliability, performance, and simplicity against how fast we need to ship.
• Mentor Senior and Staff engineers, run architecture and design reviews, and push the technical bar higher through clear direction, strong engineering habits, and honest feedback.
• Take real ownership in a fast-moving environment. Spot systemic risks early and fix the root cause instead of patching around it.

• Bachelor’s or Master’s degree in Computer Science, Engineering, or a related field, or equivalent extensive experience
• 10+ years of professional software engineering experience, with a substantial chunk at Staff-equivalent scope: architectural decisions on multi-quarter projects, made under real constraints, that you’d still defend today.
• Deep experience building and operating distributed systems at scale, high-throughput pipelines, data-intensive services. You can talk about the non-obvious failure modes, not just the happy path.
• Strong data-layer and concurrency judgment. You’ve made a relational database (Postgres or similar) do more than it wanted to, and you know when to reach for a DB lock, when Redis is the right tool, and when the right move is a design that doesn’t need either.
• Real depth in the boring-but-critical layers. Networking and egress (NAT, static IPs, connection lifecycle, DNS, TLS), the database, the container runtime. You’ve been the person the org turns to when something below the application layer is misbehaving.
• Production experience with GCP and container orchestration (Kubernetes, Knative, or similar serverless-on-k8s), and fluency in a modern backend language (Python strongly preferred; Go or similar is a plus).
• The ability to translate business goals into technical direction, and technical tradeoffs into language non-engineers can act on.
• A history of leveling up the engineers around you.

• Healthcare integrations experience — HL7 v2, FHIR, and EHRs like Epic, Cerner, or Athenahealth. We can teach the domain; we’re hiring for the systems judgment above.
• Experience with the compliance envelope this work lives inside (HIPAA, SOC 2) and the security posture that comes with handling PHI.

Please be aware that all official communication from us will come exclusively from email addresses ending in @commure.com. Any emails from other domains are not affiliated with our organization.

Employees will act in accordance with the organization’s information security policies, to include but not limited to protecting assets from unauthorized access, disclosure, modification, destruction or interference nor execute particular security processes or activities. Employees will report to the information security office any confirmed or potential events or other risks to the organization. Employees will be required to attest to these requirements upon hire and on an annual basis.