Head of Engineering, Decision Support

About Us
👏 Team from OpenAI, DeepMind, NASA, GoogleX, Tesla, and 2 physicians: 6 exits, 2 IPOs.
🔥 Our model outperforms Claude, Gemini, and GPT-4.5 on clinical benchmarks.
📈 400+ healthcare orgs signed in 16 months.
⚡️ $25M raised from YC, Amity Ventures, Sequoia scouts, and more.
🌎 $1T+ market opportunity. We’re going after all of it.

About the Role
We are seeking a Head of Engineering, Decision Support to lead the productization of ML/LLM models in mission-critical healthcare contexts. This role will own the design and delivery of decision support systems that are reliable, explainable, and trusted by clinicians. You will build and scale a team focused on inference pipelines, observability, and safety while ensuring measurable improvements in throughput, latency, and quality. As a technical leader, you will work cross-functionally with leadership, compliance, and integration teams to ensure our AI-driven decision support delivers real-world clinical impact.

Key Responsibilities

• Lead the productization of ML/LLM-powered decision support systems with strict quality, safety, and latency benchmarks.
• Build and scale engineering teams with a strong observability and reliability culture.
• Design and launch inference pipelines with fallbacks, caching, A/B evaluation, and rollback capabilities.
• Collaborate with clinicians, compliance experts, and cross-functional leaders to ensure interpretability, auditability, and clinical trust in deployed systems.
• Drive innovation in agentic workflows (e.g., recommendations, triage, treatment support) that balance automation with safety.

Hard Requirements

• Proven leadership in shipping ML/LLM systems with measurable quality, latency, and reliability outcomes.
• Deep experience in decision support contexts, including agentic or recommendation systems.
• Expertise building production-grade inference pipelines with safety, caching, and evaluation frameworks.
• Exceptional communicator able to align technical and clinical stakeholders.
• Team builder with a track record of establishing observability-first engineering practices.
• Familiarity with healthcare data standards (FHIR, HL7) and clinical reasoning patterns.
• Experience working with EHR integrations and compliance-sensitive systems.
• Background in explainable AI, interpretability, or audit trails for clinician-facing tools.
• Audit existing decision support infrastructure and identify reliability/latency bottlenecks.
• Establish engineering standards for observability, fallbacks, and A/B evaluation pipelines.
• Partner with the EHR Integrations team on upcoming FHIR-driven workflows (Q4 2025).
• Success OKRs (90 Days)

Nice-To-Have

First-Month Focus

• Launch and monitor production inference pipelines with measurable improvements in latency and throughput.
• Deliver first decision support use case with clinical interpretability and audit features enabled.
• Hire and onboard core engineering talent to scale decision support initiatives.

Culture Fit

• Persistent, driven problem solver
• Willing to push back on leadership to defend quality/timelines
• Thrives in high-ambiguity, fast-paced startup environments
• Why Join Sully.ai?
• 🔥 Shape the Future of Healthcare: Build category-defining partnerships that enable doctors to focus on saving lives.
• 📈 Early-Stage Impact: Join early and play a critical role in shaping our partnership roadmap and overall company growth.
• 🌎 Remote-First Culture: Work with a talented, mission-driven team in a flexible, remote environment.
• 💰 Competitive Compensation: Enjoy a competitive salary, equity, and the opportunity to make a real difference.
• 🏆 Solve Scalability Challenges: Tackle complex challenges in a rapidly growing company, driving impactful change in healthcare.

Sully.ai is an equal opportunity employer. In addition to EEO being the law, it is a policy that is fully consistent with our principles. All qualified applicants will receive consideration for employment without regard to status as a protected veteran or a qualified individual with a disability, or other protected status such as race, religion, color, national origin, sex, sexual orientation, gender identity, genetic information, pregnancy or age. Sully.ai prohibits any form of workplace harassment.