Heartflow is a medical technology company advancing the diagnosis and management of coronary artery disease, the #1 cause of death worldwide, using cutting-edge technology. The flagship product—an AI-driven, non-invasive cardiac test supported by the ACC/AHA Chest Pain Guidelines called the Heartflow FFRCT Analysis—provides a color-coded, 3D model of a patient’s coronary arteries indicating the impact blockages have on blood flow to the heart. Heartflow is the first AI-driven non-invasive integrated heart care solution across the CCTA pathway that helps clinicians identify stenoses in the coronary arteries (RoadMap™Analysis), assess coronary blood flow (FFRCT Analysis), and characterize and quantify coronary atherosclerosis (Plaque Analysis). Our pipeline of products is growing and so is our team; join us in helping to revolutionize precision heartcare.
Heartflow is a publicly traded company (HTFL) that has received international recognition for exceptional strides in healthcare innovation, is supported by medical societies around the world, cleared for use in the US, UK, Europe, Japan and Canada, and has been used for more than 500,000 patients worldwide.
As a Staff Application Database Architect, you will be the backend database expert behind the production applications and web services that power Heartflow's clinical and operational platform. This is a hands-on role: the majority of your time will be spent designing OLTP schemas, writing and tuning high-performance queries, and working directly inside our Python/Django services to solve real data access problems — alongside setting the architectural direction for how clinical, imaging, and operational data is structured, accessed, and governed across our AWS-based platform. Exposure to Data Lake, analytics pipelines, or AI-enablement work is a plus.
Job Responsibilities:- Design, Build & Own OLTP Database Systems: Take hands-on ownership of the transactional (OLTP) databases powering Heartflow's clinical and operational applications. Design schemas, write and optimize complex queries, and directly implement performance improvements — indexing, partitioning, connection pooling, caching — for high-throughput, low-latency web services.
- Drive Application Data Access & ORM Strategy: Define and implement best practices for how our Python/Django services interact with the database via the Django ORM. Solve real-world problems like N+1 queries, lazy-loading pitfalls, transaction isolation, connection pool exhaustion, and read/write splitting; review and directly contribute to high-impact schema and query changes in application code.
- Own Database Performance & DBA Excellence: Set direction for database operations — uptime, capacity, backups, recovery, schema evolution, and incident response. Establish SLOs, observability, and runbooks; partner with engineering and SRE teams to keep mission-critical clinical workloads fast, reliable, and secure.
- Lead Transactional Data Modeling: Own conceptual, logical, and physical data models for our operational systems. Drive consistent representation of patients, studies, cases, results, and devices, and steward the master and reference data needed for high-integrity clinical applications.
- Advance the Semantic Structure for AI Agent Context: Contribute to enriching Heartflow's transactional data model with semantics — metadata and controlled vocabularies — so AI agents and downstream consumers can reliably retrieve and reason over clinical and operational information.
- Champion Compliance, Security & Privacy: Ensure data architectures, flows, and access controls strictly adhere to FDA, HIPAA, GDPR, and other applicable standards. Partner with Quality, Regulatory, InfoSec, and Privacy teams to embed compliance into the data lifecycle by design.
- Support the Data Lake & Analytics Handoff (minor, bonus scope): For candidates with the background, partner with IT, Research, and Systems Engineering to ensure OLTP source systems produce clean, well-modeled data that feeds downstream Data Lake and analytics pipelines. This is a supporting responsibility for the right candidate, not a requirement of the role.
- Advance the Semantic Structure for AI Agent Context (minor, bonus scope): For candidates with the background, contribute to enriching Heartflow's transactional data model with semantics — metadata and controlled vocabularies — so AI agents and downstream consumers can reliably retrieve and reason over clinical and operational information.
You have experience in the following:
- OLTP Database Engineering (Primary): Deep, hands-on expertise in relational databases (PostgreSQL, MySQL, Aurora, or equivalent) supporting production web applications — schema design, query optimization, indexing, partitioning, replication, and HA/DR.
- Application & Web Service Data Access: Strong experience building backend data layers for web applications and services in Python, with expert-level fluency in SQLAlchemy and/or the Django ORM. Deep understanding of connection pooling, caching (Redis/Memcached), transaction management, and common ORM pitfalls at scale.
- Data Modeling: Expert-level conceptual, logical, and physical modeling for transactional/OLTP workloads (3NF or equivalent), including modeling for healthcare/clinical domains.
- Database Engineering & DBA Leadership: Performance tuning, partitioning, indexing strategy, replication, HA/DR, and operational excellence for production relational databases.
- Cloud Platforms: Building data systems in modern cloud ecosystems — AWS preferred (RDS/Aurora, ElastiCache, etc.) — with a strong grasp of cost, security, and reliability tradeoffs at scale.
- Healthcare Data & Compliance: Working with clinical, imaging, or device data under regulatory regimes such as FDA, HIPAA, and GDPR; familiarity with healthcare data standards (e.g., FHIR, HL7, DICOM) is a strong plus.
- Technical Leadership: Mentoring senior engineers, driving cross-team architectural decisions, establishing engineering standards, and influencing technology selection across multiple teams and programs.
Nice to have (bonus, not required):
- Analytics / Data Lake Exposure: Familiarity with Data Lake or lakehouse concepts (e.g., S3, Glue, Spark, Airflow) for the minor analytics-handoff portion of the role.
- AI Enablement & Semantic Data: Exposure to metadata, schema registries, ontologies, or semantic layers that make data usable by AI/agentic systems.
- Application-Grade Data Systems: Building rock-solid transactional databases that real clinicians and applications depend on every day.
- Engineering Excellence: Championing high-quality data systems, rigorous review and testing practices, and elevating the technical baseline of the team.
- Hands-On Ownership: Staying close to the code and the query plan — you'd rather fix the slow query yourself than just write a standard for it.
- Constructive Collaboration: Fostering open communication across Engineering, IT, Research, and Systems Engineering, and guiding healthy technical debates that result in better outcomes.
- Bachelor's degree in Computer Science, Engineering, or a related discipline, or equivalent experience. Master's preferred.
- 10+ years of relevant industry experience as a backend/application database engineer or data architect, with deep, hands-on OLTP experience supporting production web applications or web services. Data warehousing/ETL experience is a plus.
A reasonable estimate of the base salary compensation range is $190,000 to $250,000, plus bonus and equity. #LI-Hybrid
Skills Required
- Bachelor's degree in Computer Science, Engineering, or related discipline (or equivalent experience)
- Master's degree (preferred)
- 10+ years of industry experience as a backend/application database engineer or data architect supporting production web applications/web services
- Deep, hands-on expertise in relational databases (PostgreSQL, MySQL, Aurora or equivalent) for OLTP systems
- Expert-level transactional data modeling (conceptual, logical, physical) for OLTP workloads
- Strong Python experience and expert-level fluency with Django ORM and/or SQLAlchemy
- Proven experience with query optimization, indexing, partitioning, replication, HA/DR, and operational DBA practices
- Experience with connection pooling, transaction management, caching (Redis/Memcached), and solving ORM-related performance issues
- Cloud platform experience (AWS preferred) including RDS/Aurora, ElastiCache and cloud cost/security tradeoffs
- Technical leadership: mentoring senior engineers, driving cross-team architectural decisions, and establishing engineering standards
- Familiarity with healthcare data, regulatory compliance (FDA, HIPAA, GDPR) and healthcare data standards (FHIR, HL7, DICOM)
- Exposure to Data Lake / analytics pipelines (S3, Glue, Spark, Airflow)
- Experience with metadata, schema registries, ontologies, or semantic layers for AI enablement
What We Do
Heartflow is the global leader in AI-driven coronary artery disease (CAD) management, transforming how CAD — the world’s leading cause of death — is diagnosed and treated. Our advanced technology generates personalized, precision 3D heart models from a single CT scan, providing clinicians with the clarity and confidence to deliver earlier, more effective treatments — transforming CAD into a disease that can be managed for life. Heartflow One is the only complete, non-invasive, precision coronary care platform providing patient insights throughout the guideline-directed CCTA pathway. The AI-driven platform — including Roadmap™ Analysis, FFRCT Analysis and Plaque Analysis — is supported by the ACC/AHA Chest Pain Guideline and backed by more than 600 peer-reviewed publications. With over 400,000 patients treated, more than 1,400 leading institutions adopting our solution, and 99.5% of U.S. lives covered — Heartflow is redefining the standard of coronary care. We're a global company, with employees across the United States, Europe and Japan. Our headquarters are in Mountain View, California, with additional offices in California, Texas, the UK, and Japan. We believe CAD shouldn’t be a silent threat. By making it screenable, diagnosable, and manageable, we’re changing the story of CAD, empowering clinicians to save lives and giving patients more time for what matters most.
Why Work With Us
Join Us to Rewrite the Story of CAD.
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